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Minakovskaya et al. (Abstract)

Cellular Therapy and Transplantation (CTT), Vol. 3, No. 9
doi: 10.3205/ctt-2010-No9-abstract51
© The Authors. This abstract is provided under the following license: Creative Commons Attribution 3.0 Unported

Abstract accepted for "4th Raisa Gorbacheva Memorial Meeting on Hematopoietic Stem Cell Transplantation",
Saint Petersburg, Russia, September 18–20, 2010

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The effect of mesenchymal stem cell (MSC) transplantation in the treatment of steroid-resistant GVHD in pediatric patients

Nina V. Minakovskaya, Yanina I. Isaikina, Natalia P. Kirsanova, Olga V. Aleinikova

Belarusian Research Center for Pediatric Oncology and Hematology, Minsk, Belarus

Correspondence: Nina V. Minakovskaya, Belarusian Research Center for Pediatric Oncology and Hematology, Pos. Lesnoe-2, 223040, Minsk reg., Belarus, E-mail: minakovskaya@spam is badtut.by

Abstract

Aim: We analyzed the clinical effect of MSC infusion for the treatment of severe steroid-resistant GVHD.

Patients and methods: Twenty-seven children were included in our study. All patients received GVHD prophylaxis after allogenic hematopoietic stem cell transplantation (HSCT): for pts with ALL, / MDS,/ CML,/ CMML, and/ NHL this  consisted of CSA and MTX; for pts with SAA, - CSA+MMF; for pts with AML, - CSA and MTX, and for pts with AF, methylprednisolone + tacrolimus. All pts received methylprednisolone 1–2 mg/kg for the treatment of GVHD, however they developed steroid-resistant acute (grade II–IV) and chronic extensive GVHD. The patients were divided in two groups: 1 group -of 16 patients (median age 15 years, male/ female: 12/4) with AML- (6), MDS- (1), NHL- (1), ALL- (5), and SAA/AF (-3) underwent MSCs infusion after HSCT for the treatment of steroid-resistant acute or chronic GVHD. Nine pts received MSCs once and seven, – twice. The median first dose of MSCs was 1.5 (0.5–5.4)x106/kg and the second dose, – 1.0 (0.7–2.5)x106/kg. The MSCs were derived from the bone marrow of HSCs donors (HLA-identical donors,) ( n = 7) and third-party HLA-mismatched donors (n = 8). The second group -of 11 children was the control group who didn’t receive MSC therapy, (median age 15 years, male/ female: 5/6) with AML- (2), ALL- (4), SAA/AF- (3), HML- (1), and HMML- (1).

Results
: No patients experienced side -effects during or immediately after the MSC infusions. The incidence of death from GVHD amounted to 18% in the group of patients given MSCs compared with 55% in the group of children that received immunosuppressive therapy alone (p=0.04). The median survival duration from allogenic HSCT was 23.6 (8.4–45.2) months in the MSC patient group, and 4.6 (2.2–47.3) months in the group of pts without MSC (p=0.03). Overall survival (OS) was 0.34±0.16 in the MSC patient group, and 0.18±0.11 in the group of patients without MSC (p=0.02). Ten patients had acute steroid-resistant GVHD and six patients had chronic GVHD among the children that received MSCs. The incidence of death from GVHD was 62% and 0%, respectively. OS from GVHD alone averaged 0.38±0.8 for acute and 1.0 for chronic GVHD (p<0.05).

Conclusion:
This study confirms the rationale of administering MSCs for treatment of steroid-resistant GVHD, for reduction in deaths from GVHD, and an increase in OS in children after allogeneic HSCT. Our data suggests MSCs’ efficacy in treatment of the chronic form of steroid-resistant GVHD. 

Keywords: steroid-resistant GVHD, mesenchymal stem cells transplantation

 

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