Are mesenchymal stem cells still effective in acute GvHD management?

Bahar Uncu Ulu; Ipek Yonal Hindilerden; Tugce Nur Yigenoglu; Tarik Onur Tiryaki; Mehmet Ali Erkurt; Gulten Korkmaz; Sinem Namdaroglu; Elif Aksoy; Serdal Korkmaz; Mert Seyhan; Seda Yilmaz; Sevgi Kalayoglu Besisik; Mehmet Sinan Dal; Turgay Ulas; Fevzi Altuntas

doi:10.1016/j.transci.2024.104051

Are mesenchymal stem cells still effective in acute GvHD management?

Transfus Apher Sci. 2024 Dec 16;64(1):104051. doi: 10.1016/j.transci.2024.104051. Online ahead of print.

Authors

Affiliations

¹ University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, Ankara, Turkey. Electronic address: baharuncu@gmail.com.
² Istanbul University Istanbul Medical Faculty, Department of Internal Medicine, Division of Hematology, Istanbul, Turkey.
³ University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, Ankara, Turkey.
⁴ Inonu University, Faculty of Medicine, Department of Hematology, Malatya, Turkey.
⁵ Ankara Bilkent City Hospital, Department of Hematology and Bone Marrow Transplantation Unit, Ankara, Turkey.
⁶ Dokuz Eylul University, Faculty of Medicine, Department of Hematology, Izmir, Turkey.
⁷ University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Clinic of Hematology, Istanbul, Turkey.
⁸ University of Health Sciences, Kayseri Medical Faculty, Department of Hematology and Bone Marrow Transplantation Unit, Kayseri, Turkey.
⁹ University of Health Sciences, Konya Medical Faculty, Department of Hematology and Bone Marrow Transplantation Unit, Konya, Turkey.
¹⁰ University of Health Sciences, Ankara Oncology Training and Research Hospital, Department of Hematology & Apheresis Unit, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Department of Internal Medicine, Division of Hematology, Ankara, Turkey.

PMID: 39721135
DOI: 10.1016/j.transci.2024.104051

Abstract

Objective: Graft-versus-host disease (GvHD) is a common and serious complication following allogeneic hematopoietic stem cell transplantation (allo-HSCT), significantly impacting transplant efficacy. In the treatment of GvHD, numerous therapeutic approaches have been explored, with mesenchymal stem cells (MSCs) emerging as a prominent immunomodulatory option. We aimed to evaluate efficacy and outcomes of using MSCs for steroid refractory acute GVHD (SR-aGvHD) management.

Materials and methods: We retrospectively analyzed data from 36 patients' who received MSCs for treatment of SR-aGvHD following allo-HSCT between 2018 and 2024 from nine transplantation centers in Türkiye. The product consisted of umbilical cord-derived allogeneic MSCs, which were administered intravenously.

Results: Our cohort was at the median age of 39 years (range: 19-61 years), with aGvHD diagnosed at a median of two months after allo-HSCT. More than half of the patients (58.3 %) classified as high-grade aGvHD according to the Minnesota risk scoring. Cord blood-derived MSCs were administered at a median dose of 3.45 (range: 0.8-5) million MSCs/kg, with a median of 3th (range: 2-5) line treatment. The rate of responses exceeding partial response (PR) was approximately 20 % at the first month, increasing to 24 % at the second month. The six-month survival rate was 33 %, with 46 % of mortality attributed to sepsis and 12.5 % related to GvHD. Multivariate analysis indicated that increasing age (≥35 years) and lower platelet counts (≤75 x10⁹/L) were associated with higher mortality (p < 0.05).

Conclusion: MSC therapy has shown promising potential in improving response rates in aGvHD treatment, with efficacy enhanced by younger age and higher platelet counts.

Keywords: Graft vs host disease; Hematopoietic stem cell transplantation; Mesenchymal stem cells.