Mesenchymal stem cells appear helpful in graft-versus-host disease

Last Updated: 2015-12-09

By David Douglas

NEW YORK (Reuters Health) - Infusion of mesenchymal stem cells (MSC) may be of benefit in patients with steroid-refractory acute graft-versus-host disease (GVHD), according to a new meta-analysis of non-randomized studies.

"Steroid-refractory acute graft-versus-host disease is a highly fatal condition with no good treatments," Dr. Shahrukh Hashmi from the Mayo Clinic in Rochester, Minnesota, told Reuters Health by email. "Mesenchymal stem cell therapy is a reasonable choice of treatment once steroids fail, and has an acceptable 6 month survival."

Dr. Hashmi and colleagues conducted a systematic review of the literature and also searched for unpublished studies. They found 13 observational studies involving 336 patients.

The team found 12 studies with data for overall survival in 261 patients, they report in The Lancet Haematology, online November 27. Half of the patients were alive at the longest follow-up of each study. Six studies including 119 patients showed that survival at six months after MSC treatment was 63%. Most patients who survived responded to the MSC intervention.

There was no difference in the number of patients achieving an overall and complete response with respect to age, culture medium, or dose of MSC delivered, the researchers say. The overall response for both acute gastrointestinal GVHD and acute skin GVHD was 49%, compared to only 28% of patients with acute liver GVHD.

"Because the included studies were not comparative, confidence in the available estimates about treatment effectiveness is low," the researchers caution.

Still, they say, "Shared decision-making strategies using our survival and response estimates could help clinicians and patients to proceed with options most consistent with their preferences."

Dr. Hashmi concluded: "Randomized clinical trials are urgently needed for this orphan disease."

SOURCE: http://bit.ly/1NhN8vk

Lancet Haematol 2015.