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Cellular Therapy

Mesenchymal stromal cell infusion to treat steroid-refractory acute GvHD III/IV after hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 52, pages 859–862 (2017)Cite this article

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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.

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Acknowledgements

We thank Patrícia A Tozetti, Patrícia VB Palma and Camila COM Bonaldo for technical assistance. This work received financial support from FINEP (01.08.0591.03); CNPq (310619/2012-2); and Center for Cell-based Therapy–São Paulo Research Foundation FAPESP (CEPID 13/08135-2).

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Authors and Affiliations

  1. Center for Cell-Based Therapy, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil

    G M Dotoli, G C De Santis, M D Orellana, K de Lima Prata, S R Caruso & T R Fernandes

  2. Coordenador do Serviço de Transplante de Medula Óssea do Hospital Amaral Carvalho, Jaú, Brazil

    V A Rensi Colturato

  3. Oncology and Hematology, Hospital Israelita Albert Einstein, São Paulo, Brazil

    A T Kondo

  4. Hematology and Bone Marrow Transplantation, Hospital Israelita Albert Einstein, São Paulo, Brazil

    N Hamerschlak

  5. Hematology Division, Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil

    B P Simões

  6. 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

    D T Covas

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  1. G M Dotoli
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Correspondence to G M Dotoli.

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Dotoli, G., De Santis, G., Orellana, M. et al. Mesenchymal stromal cell infusion to treat steroid-refractory acute GvHD III/IV after hematopoietic stem cell transplantation. Bone Marrow Transplant 52, 859–862 (2017). https://doi.org/10.1038/bmt.2017.35

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