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Third party mesenchymal stromal cell infusions fail to induce tissue repair despite successful control of severe grade IV acute graft-versus-host disease in a child with juvenile myelo-monocytic leukemia

Leukemia volume 22, pages 1256–1257 (2008)Cite this article

Progressive steroid refractory grade IV graft-versus-host disease (GvHD) is generally considered to be a fatal disease. The use of allogeneic bone marrow-derived expanded mesenchymal stromal cells (MSCs) has been reported as a novel treatment for this condition.1 Recently, Ringden et al.2 reported potential tissue repair during MSC infusions in patients undergoing allogeneic stem cell transplantation. We found a dissimilar outcome within the gastrointestinal (GI) tract of a child treated with MSCs for steroid refractory GvHD and thus would like to express caution in the interpretation of these findings.

A 15-month-old girl underwent a 6/6-matched unrelated cord blood transplant for a diagnosis of juvenile myelo-monocytic leukemia. Conditioning consisted of intravenous Busulfex 120 mg m−2 daily with targeted drug dosing (day −9 to −6), cyclophosphamide 60 mg kg−1 daily (day −5 and −4) with Mesna prophylaxis, melphalan 140 mg m−2 (day −1) and antithymocyte globulin (ATG-Sangstat Imtix day −6 to −2) at a dose of 2.5 mg kg−1 day−1. GvHD prophylaxis consisted of cyclosporine 2 mg kg−1 day−1 from day –1 given intravenously with dose adjustment according to the results of regular blood sampling. Prednisolone 1 mg kg−1 day−1 was administered from day +5 onward.

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Acknowledgements

The authors wish to acknowledge the medical and ancillary staff of the LUMC Leiden and the Sophia Children's Hospital, Rotterdam for contributing to the overall excellent care of the patient, Professor Dr Johannes Morreau; Pathology, LUMC for the pathological preparations; the Medical Photography Department of the LUMC; Dr Wouter Kollen Pediatrics, LUMC for preparing the illustrations and Dr Helene Roelofs of the Stem Cell Laboratory for the MSC cultures. This work is partly supported by grants from the Dutch Program for Tissue Engineering.

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Authors and Affiliations

  1. Department of Pediatric Immunology, Hematology/Oncology and Stem Cell Transplantation, Leiden University Medical Center, Leiden, The Netherlands

    L Ball, R Bredius, A Lankester & M Egeler

  2. Department of Gastro-Enterology, Leiden University Medical Center, Leiden, The Netherlands

    J Schweizer

  3. Department of Pediatrics Oncology/Hematology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands

    M van den Heuvel-Eibrink

  4. Department of Gastro-Enterology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands

    H Escher

  5. Department of Immunohematology and Stem Cell Research, Leiden University Medical Center, Leiden, The Netherlands

    W Fibbe

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  1. L Ball
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Correspondence to L Ball.

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Ball, L., Bredius, R., Lankester, A. et al. Third party mesenchymal stromal cell infusions fail to induce tissue repair despite successful control of severe grade IV acute graft-versus-host disease in a child with juvenile myelo-monocytic leukemia. Leukemia 22, 1256–1257 (2008). https://doi.org/10.1038/sj.leu.2405013

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