title: Mesenchymal stromal cell infusion to treat steroid-refractory acute GvHD III/IV after hematopoietic stem cell transplantation.
abstract: Acute GvHD (aGvHD) is a life-threatening complication of hematopoietic stem cell transplantation. Frontline therapy for aGvHD consists of corticosteroid administration. However, ∼25% of the patients have a steroid-refractory disease, a sign of poor prognosis. An alternative therapy for steroid-refractory aGvHD is infusion of mesenchymal stromal cells (MSCs). Herein, we report the results of 46 patients treated with MSC infusion as salvage therapy for steroid-refractory aGvHD III/IV (78% grade IV). Patients received a median cumulative dose of MSCs of 6.81 × 106/kg (range, 0.98-29.78 × 106/kg) in a median of 3 infusions (range, 1-7). Median time between the onset of aGvHD and the first MSC infusion was 25.5 days (range, 6-153). Of the patients, 50% (23/46) presented clinical improvement. Of these, 3 patients (13%) had complete response, 14 (61%) had partial response and 6 (26%) had transient partial response. The estimated probability of survival at 2s year was 17.4%. Only 2 patients (4.3%) presented acute transient side effects (nausea/vomiting and blurred vision) during cell infusion. No patient had late or severe side effects because of MSC infusion. These results suggest that this therapeutic modality is safe and should be considered for steroid-refractory aGvHD, especially in countries where other second-line agents are less available.
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: G M
authors.initials: GM
authors.lastname: Dotoli
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: G C
authors.initials: GC
authors.lastname: De Santis
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: M D
authors.initials: MD
authors.lastname: Orellana
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: K
authors.initials: K
authors.lastname: de Lima Prata
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: S R
authors.initials: SR
authors.lastname: Caruso
authors.affiliation: Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: T R
authors.initials: TR
authors.lastname: Fernandes
authors.affiliation: Coordenador do Serviço de Transplante de Medula Óssea do Hospital Amaral Carvalho, Jaú, Brazil.
authors.forename: V A
authors.initials: VA
authors.lastname: Rensi Colturato
authors.affiliation: Oncology and Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: A T
authors.initials: AT
authors.lastname: Kondo
authors.affiliation: Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil.
authors.forename: N
authors.initials: N
authors.lastname: Hamerschlak
authors.affiliation: Hematology Division, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: B P
authors.initials: BP
authors.lastname: Simões
authors.affiliation: Center for Cell-Based Therapy and Hematology Division, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil.
authors.forename: D T
authors.initials: DT
authors.lastname: Covas
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000401:mortality / Q000628:therapy; D019337:Hematologic Neoplasms / Q000401:mortality / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D045164:Mesenchymal Stem Cell Transplantation; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage; D015996:Survival Rate
chemical_list: D013256:Steroids