Mesenchymal stem cells transplantation in hematological patients with acute graft-versus-host disease: characteristics and risk factors for infectious complications

Abstract

The role of MSCs in infection prevention and treatment is still discussed in transplant and hematological patients. The spectrum and risk factors for infections after MSCs transplantation in patients with acute GVHD have not been studied before. To determine the risk factors and spectrum of infectious complications in patients received mesenchymal stem cell transplantation as a treatment for acute GVHD. A prospective observational study was performed to evaluate the risk factors and characteristics of infectious complications after MSCs transplantation in adult patients having acute GVHD. Thirty-four episodes of MSCs transplantation in patients with acute GVHD after allogeneic HSCT were enrolled in the study. MSCs were given at a median dose of 1.32 (interquartile range 0.87-2.16) mln cells/kg per infusion at 91 days (interquartile range 31-131 days) after HSCT. Data relating to age, gender, date, and type of transplantation, characteristics of MSCs, infectious agents, and antimicrobial therapy and prevention regimens were prospectively collected in all of the enrolled patients. The episode of proven infectious complication was set as a primary outcome. There were totally 68 patients with acute GVHD in the study; among them there were 34 cases of MSCs transplantation performed. Among the registered infectious episodes were viral infections (CMV-associated disease, EBV-associated disease), invasive pulmonary aspergillosis, bacterial bloodstream infections, and pneumonia. MSCs transplantation has shown no statistically significant association with risk of infectious complications in patients with acute GVHD in a performed multivariate analysis. Among the most frequent infections in acute GVHD, we have described CMV, invasive aspergillosis, and bacterial infections (bloodstream infections or pneumonia). Among risk factors for infectious complications in patients with acute GVHD with/without MSCs transplantation are progression of main disease and neutropenia below 500 cells/mm (for aspergillosis) and unrelated HSCT in the past history and progression of main disease (for bacterial bloodstream infections and pneumonia).

Anti-proliferative effects of mesenchymal stem cells (MSCs) derived from multiple sources on ovarian cancer cell lines: an in-vitro experimental study

“…The therapeutic potential of MSCs has been explored in a number of phase I, II, and III clinical trials [23], of which several were targeted against graft versus-host disease and to support engraftment of hematopoietic stem cells [24, 25]. Yet, very few of these trials use MSCs to treat tumor diseases [23, 26, 27], such as gastrointestinal, lung, and ovarian cancer.…”

Mesenchymal stroma/stem cells: Haematologists’ friend or foe?

“…They showed a trend towards clinical efficacy in patients with SR grade II–IV aGVHD, with a marginal six‐month OS difference between those receiving MSCs and the historical control group (58.82% vs 38.24%; p = 0.0678). In this relatively small study, no statistically significant risk of bacterial infections, cytomegalovirus (CMV) disease and invasive fungal disease was observed 72 . Cetin et al treated 17 patients with aGVHD; survival rate at six months was 69.2% in the responder group ( n = 13) compared with no survival in the non‐responder group ( n = 4) 73 .…”

The Use of Allogeneic Mesenchymal Stem Cell in Childhood Steroid- Resistant Acute Graft-Versus-Host Disease: A Retrospective Study, Single Center Experience

“…We did not evaluate whether the infection rate had increased. Other studies have not reported an adverse effect that increased the rate of infection [12,26,27].…”