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Efficacy of Mesenchymal Stem Cell Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease following Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

Chen X, Wang C, Yin J, Xu J, Wei J, Zhang Y - PLoS ONE (2015)

Bottom Line: In total, 205 patients exhibited overall response (ORR).Completion therapy may improve the CR but reduce ORR compared with induction therapy (CR: OR = 0.20, 95%CI: 0.09-0.44, p < 0.05; ORR: OR = 2.18, 95%CI: 1.17-4.05, p = 0.01).There was also a trend towards a better clinical response in children compared with adults (CR: OR = 2.41, 95%CI: 1.01-5.73, p = 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

ABSTRACT

Background: Mesenchymal stem cells (MSCs) have been broadly used experimentally in various clinical contexts. The addition of MSCs to initial steroid therapy for acute graft-versus-host disease (aGVHD) may improve patient outcomes. However, investigations regarding prognostic factors affecting the efficacy of MSC therapy for steroid-refractory aGVHD remain controversial. We thus conducted a systematic review and meta-analysis of published clinical trials to determine possible prognostic factors affecting the efficacy of MSCs in treating steroid-refractory aGVHD.

Methods and findings: Clinical trials using MSC therapy for steroid-refractory aGVHD were identified by searching PubMed and EMBASE databases. A total of 6,963 citations were reviewed, and 13 studies met the inclusion criteria. A total of 301 patients from thirteen studies were included. Of these, 136 patients showed a complete response (CR), and 69 patients displayed a partial (PR) or mixed response (MR). In total, 205 patients exhibited overall response (ORR). Patients with skin steroid-refractory aGVHD showed a better clinical response than gastrointestinal (CR: odds ratio [OR] = 1.93, 95% confidence interval [95%CI]: 1.05-3.57, p < 0.05) and liver (CR: OR = 2.30, 95%CI: 1.12-4.69, p < 0.05, and ORR: OR = 2.93, 95%CI: 1.06-8.08, p < 0.05) steroid-refractory aGVHD. Those with grade II steroid-refractory aGVHD exhibited a better clinical response following MSC therapy than recipients with grade III-IV (CR: OR = 3.22, 95%CI: 1.24-8.34, p < 0.05). Completion therapy may improve the CR but reduce ORR compared with induction therapy (CR: OR = 0.20, 95%CI: 0.09-0.44, p < 0.05; ORR: OR = 2.18, 95%CI: 1.17-4.05, p = 0.01). There was also a trend towards a better clinical response in children compared with adults (CR: OR = 2.41, 95%CI: 1.01-5.73, p = 0.05).

Conclusions: Age, skin involvement, lower aGVHD grade, and the number of infusions are the main prognostic factors affecting the efficacy of MSC therapy for steroid-refractory aGVHD.

No MeSH data available.


Related in: MedlinePlus

Flow diagram of the literature search process for identifying studies.
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pone.0136991.g001: Flow diagram of the literature search process for identifying studies.

Mentions: A systematic search of PubMed and EMBASE databases yielded 441 and 6522 results, respectively. After removing duplicates, the titles and abstracts from the remaining 6809 studies were screened, and 25 potentially eligible studies for the meta-analysis were retained. After retrieving the full-text version of the aforementioned 25 studies, one study was excluded because they used MSCs to treat aGVHD as a first-line therapy rather than steroid-refractory aGVHD. Four studies did not provide sufficient data. Eight studies were excluded because they were not clinical trials. The literature search process is summarized in Fig 1.


Efficacy of Mesenchymal Stem Cell Therapy for Steroid-Refractory Acute Graft-Versus-Host Disease following Allogeneic Hematopoietic Stem Cell Transplantation: A Systematic Review and Meta-Analysis.

Chen X, Wang C, Yin J, Xu J, Wei J, Zhang Y - PLoS ONE (2015)

Flow diagram of the literature search process for identifying studies.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554731&req=5

pone.0136991.g001: Flow diagram of the literature search process for identifying studies.
Mentions: A systematic search of PubMed and EMBASE databases yielded 441 and 6522 results, respectively. After removing duplicates, the titles and abstracts from the remaining 6809 studies were screened, and 25 potentially eligible studies for the meta-analysis were retained. After retrieving the full-text version of the aforementioned 25 studies, one study was excluded because they used MSCs to treat aGVHD as a first-line therapy rather than steroid-refractory aGVHD. Four studies did not provide sufficient data. Eight studies were excluded because they were not clinical trials. The literature search process is summarized in Fig 1.

Bottom Line: In total, 205 patients exhibited overall response (ORR).Completion therapy may improve the CR but reduce ORR compared with induction therapy (CR: OR = 0.20, 95%CI: 0.09-0.44, p < 0.05; ORR: OR = 2.18, 95%CI: 1.17-4.05, p = 0.01).There was also a trend towards a better clinical response in children compared with adults (CR: OR = 2.41, 95%CI: 1.01-5.73, p = 0.05).

View Article: PubMed Central - PubMed

Affiliation: Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

ABSTRACT

Background: Mesenchymal stem cells (MSCs) have been broadly used experimentally in various clinical contexts. The addition of MSCs to initial steroid therapy for acute graft-versus-host disease (aGVHD) may improve patient outcomes. However, investigations regarding prognostic factors affecting the efficacy of MSC therapy for steroid-refractory aGVHD remain controversial. We thus conducted a systematic review and meta-analysis of published clinical trials to determine possible prognostic factors affecting the efficacy of MSCs in treating steroid-refractory aGVHD.

Methods and findings: Clinical trials using MSC therapy for steroid-refractory aGVHD were identified by searching PubMed and EMBASE databases. A total of 6,963 citations were reviewed, and 13 studies met the inclusion criteria. A total of 301 patients from thirteen studies were included. Of these, 136 patients showed a complete response (CR), and 69 patients displayed a partial (PR) or mixed response (MR). In total, 205 patients exhibited overall response (ORR). Patients with skin steroid-refractory aGVHD showed a better clinical response than gastrointestinal (CR: odds ratio [OR] = 1.93, 95% confidence interval [95%CI]: 1.05-3.57, p < 0.05) and liver (CR: OR = 2.30, 95%CI: 1.12-4.69, p < 0.05, and ORR: OR = 2.93, 95%CI: 1.06-8.08, p < 0.05) steroid-refractory aGVHD. Those with grade II steroid-refractory aGVHD exhibited a better clinical response following MSC therapy than recipients with grade III-IV (CR: OR = 3.22, 95%CI: 1.24-8.34, p < 0.05). Completion therapy may improve the CR but reduce ORR compared with induction therapy (CR: OR = 0.20, 95%CI: 0.09-0.44, p < 0.05; ORR: OR = 2.18, 95%CI: 1.17-4.05, p = 0.01). There was also a trend towards a better clinical response in children compared with adults (CR: OR = 2.41, 95%CI: 1.01-5.73, p = 0.05).

Conclusions: Age, skin involvement, lower aGVHD grade, and the number of infusions are the main prognostic factors affecting the efficacy of MSC therapy for steroid-refractory aGVHD.

No MeSH data available.


Related in: MedlinePlus