Applying mesenchymal stem cells for the prevention and treatment of steroid-resistant GVHD in children in Belarus
Nina V. Minakovskaya, Yanina I. Isaikina, 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, Minski distr., Pos. Lesnoe, Minsk, Belarus, 223053, Phone: +375 17 265 40 89, Fax: +375-17-265-42-22
E-mail: minakovskaya@tut.by
Summary
Objective
We analyzed the clinical effect of MSC infusion on day +30 after
HSCT as a GVHD prophylaxis and the application of MSCs as a treatment of severe steroid–resistant GVHD.
Patients and methods
Nine pts after allogeneic hematopoietic stem cell transplantation (HSCT) underwent MSC infusions (median age was 11 years, 6 males, 3 females) between 2006 and 2009.
Diagnoses
ALL – 4, AML – 1, AA – 3, MDS – 1. GVHD prophylaxis for pts with ALL and MDS consisted of CSA and MTX 10 mg/m2 (n=3); for pts with AA, CSA+MMF; for pts with AML, CSA and MTX 10 mg/m2 (n=4). For the treatment of GVHD all pts received methylprednisolone 1–2 mg/kg. Five pts received MSCs once and 4 pts, twice. For 4 pts MSCs were used as a GVHD prophylaxis on day +30 after HSCT; the median dose was 1.0 (0.7–1.5)x10^6/kg. Five pts received MSCs for the treatment of steroid–resistant GVHD with a medium time of MSC infusion after HSCT of 126 (110–151) days and a mean dose of 2.2 (1.3–3.7)x10^6/kg.
Results
There was no evidence of early or late side effects of MSC infusion. One patient died from pulmonary GVHD 1 month after MSC infusion, while eight pts are alive. All pts (n=4) who received MSCs on day +30 as a GVHD prophylaxis developed grades II–IV GVHD and needed a secondary MSC infusion; the median time between MSC infusions was 120(90–150) days.
Four pts out of five with steroid-resistant GVHD showed significant improvement of the clinical signs of GVHD; this allowed the reduction of immunosuppressive therapy and the cessation of steroids.
Conclusion
Our experience demonstrates the absence of a positive GVHD prophylactic efficacy when MSC infusion was carried out on day +30. However, we observed a decrease of GVHD grades III–IV to 0–II, when MSCs were used as a treatment of steroid-resistant GVHD.
Keywords
GVHD, MSC, allogeneic HSCT
