Mesenchymal stromal cells for treatment of steroid-refractory GvHD: a review of the literature and two pediatric cases
Severe acute graft versus host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs) play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising...
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| Published in: | International archives of medicine Vol. 4; no. 1; p. 27 |
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| Main Authors: | , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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BioMed Central Ltd
15-08-2011
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| Abstract | Severe acute graft versus host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs) play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising tool for the treatment of steroid-refractory GvHD. To date, a few reports exist on the use of MSCs in treatment of GvHD in children indicating that children tend to respond better than adults, albeit with heterogeneous results.We here present a review of the literature and the clinical course of two instructive pediatric patients with acute steroid-refractory GvHD after haploidentical stem cell transplantation, which exemplify the beneficial effects of third-party transplanted MSCs in treatment of acute steroid-refractory GvHD. Moreover, we provide a meta-analysis of clinical studies addressing the outcome of patients with steroid-refractory GvHD and treatment with MSCs in adults and in children (n = 183; 122 adults, 61 children). Our meta-analysis demonstrates that the overall response-rate is high (73.8%) and confirms, for the first time, that children indeed respond better to treatment of GvHD with MSCs than adults (complete response 57.4% vs. 45.1%, respectively).These data emphasize the significance of this therapeutic approach especially in children and indicate that future prospective studies are needed to assess the reasons for the observed differential response-rates in pediatric and adult patients. |
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| AbstractList | Severe acute graft versus host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs) play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising tool for the treatment of steroid-refractory GvHD. To date, a few reports exist on the use of MSCs in treatment of GvHD in children indicating that children tend to respond better than adults, albeit with heterogeneous results. Severe acute graft versus host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs) play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising tool for the treatment of steroid-refractory GvHD. To date, a few reports exist on the use of MSCs in treatment of GvHD in children indicating that children tend to respond better than adults, albeit with heterogeneous results. We here present a review of the literature and the clinical course of two instructive pediatric patients with acute steroid-refractory GvHD after haploidentical stem cell transplantation, which exemplify the beneficial effects of third-party transplanted MSCs in treatment of acute steroid-refractory GvHD. Moreover, we provide a meta-analysis of clinical studies addressing the outcome of patients with steroid-refractory GvHD and treatment with MSCs in adults and in children (n = 183; 122 adults, 61 children). Our meta-analysis demonstrates that the overall response-rate is high (73.8%) and confirms, for the first time, that children indeed respond better to treatment of GvHD with MSCs than adults (complete response 57.4% vs. 45.1%, respectively). These data emphasize the significance of this therapeutic approach especially in children and indicate that future prospective studies are needed to assess the reasons for the observed differential response-rates in pediatric and adult patients. Severe acute graft versus host disease (GvHD) is a life-threatening complication after allogeneic hematopoietic stem cell transplantation. Human mesenchymal stromal cells (MSCs) play an important role in endogenous tissue repair and possess strong immune-modulatory properties making them a promising tool for the treatment of steroid-refractory GvHD. To date, a few reports exist on the use of MSCs in treatment of GvHD in children indicating that children tend to respond better than adults, albeit with heterogeneous results. We here present a review of the literature and the clinical course of two instructive pediatric patients with acute steroid-refractory GvHD after haploidentical stem cell transplantation, which exemplify the beneficial effects of third-party transplanted MSCs in treatment of acute steroid-refractory GvHD. Moreover, we provide a meta-analysis of clinical studies addressing the outcome of patients with steroid-refractory GvHD and treatment with MSCs in adults and in children (n = 183; 122 adults, 61 children). Our meta-analysis demonstrates that the overall response-rate is high (73.8%) and confirms, for the first time, that children indeed respond better to treatment of GvHD with MSCs than adults (complete response 57.4% vs. 45.1%, respectively). These data emphasize the significance of this therapeutic approach especially in children and indicate that future prospective studies are needed to assess the reasons for the observed differential response-rates in pediatric and adult patients. |
| Audience | Academic |
| Author | Kolb, Hans-Jochem Hendrik, Juenger Koehl, Ulrike von Luettichau, Irene Bader, Peter Lawitschka, Anita Wernicke, Caroline M Kuci, Selim Mueller, Ingo Doering, Michaela Burdach, Stefan Kuci, Zyrafete Peters, Christina Grunewald, Thomas Gp |
| AuthorAffiliation | 2 Medical Life Science and Technology Center, TUM Graduate School, Technische Universität München, Boltzmannstrasse 17, 85748 Garching, Germany 4 University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany 5 University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076 Tuebingen, Germany 7 Division for Stem Cell Transplantation, Department of Medicine III, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany 1 Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany 6 St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria 3 Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany |
| AuthorAffiliation_xml | – name: 2 Medical Life Science and Technology Center, TUM Graduate School, Technische Universität München, Boltzmannstrasse 17, 85748 Garching, Germany – name: 7 Division for Stem Cell Transplantation, Department of Medicine III, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany – name: 3 Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany – name: 1 Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany – name: 4 University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany – name: 6 St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria – name: 5 University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076 Tuebingen, Germany |
| Author_xml | – sequence: 1 givenname: Caroline M surname: Wernicke fullname: Wernicke, Caroline M organization: Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany – sequence: 2 givenname: Thomas Gp surname: Grunewald fullname: Grunewald, Thomas Gp organization: Medical Life Science and Technology Center, TUM Graduate School, Technische Universität München, Boltzmannstrasse 17, 85748 Garching, Germany – sequence: 3 givenname: Juenger surname: Hendrik fullname: Hendrik, Juenger organization: Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany – sequence: 4 givenname: Selim surname: Kuci fullname: Kuci, Selim organization: Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany – sequence: 5 givenname: Zyrafete surname: Kuci fullname: Kuci, Zyrafete organization: Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany – sequence: 6 givenname: Ulrike surname: Koehl fullname: Koehl, Ulrike organization: Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany – sequence: 7 givenname: Ingo surname: Mueller fullname: Mueller, Ingo organization: University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany – sequence: 8 givenname: Michaela surname: Doering fullname: Doering, Michaela organization: University Children's Hospital, Hoppe-Seyler-Strasse 1, 72076 Tuebingen, Germany – sequence: 9 givenname: Christina surname: Peters fullname: Peters, Christina organization: St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria – sequence: 10 givenname: Anita surname: Lawitschka fullname: Lawitschka, Anita organization: St. Anna Children's Hospital, Kinderspitalgasse 6, 1090 Vienna, Austria – sequence: 11 givenname: Hans-Jochem surname: Kolb fullname: Kolb, Hans-Jochem organization: Division for Stem Cell Transplantation, Department of Medicine III, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany – sequence: 12 givenname: Peter surname: Bader fullname: Bader, Peter organization: Division for Stem Cell Transplantation, Department of Hematology, Oncology and Hemostasis, Hospital for Children and Adolescents, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany – sequence: 13 givenname: Stefan surname: Burdach fullname: Burdach, Stefan organization: Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany – sequence: 14 givenname: Irene surname: von Luettichau fullname: von Luettichau, Irene organization: Children's Cancer Research and Roman Herzog Comprehensive Cancer Center, Department of Pediatrics, Klinikum rechts der Isar, Technische Universität München, Kölner Platz 1, 80804 Munich, Germany |
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| SubjectTerms | Care and treatment Case Report Graft versus host reaction Stem cells Transplantation |
| Title | Mesenchymal stromal cells for treatment of steroid-refractory GvHD: a review of the literature and two pediatric cases |
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