The Use of Allogeneic Mesenchymal Stem Cells in Childhood Steroid-Resistant Acute Graft-Versus-Host Disease: A Retrospective Study of a Single-Center ExperienceCeyhun Bozkurt1, Erdal Karaöz2, Başak Adaklı Aksoy1, Selime Aydoğdu3, Tunç Fışgın31İstinye University Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey; Altınbaş University Faculty of Medicine, Bahçelievler Medical Park Hospital Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
2İstinye University Faculty of Medicine, Department of Histology-Embryology, İstanbul, Turkey; İstinye University Faculty of Medicine, Stem Cell and Tissue Engineering Research and Application Center, İstanbul, Turkey; Liv Hospital, Regenerative Medicine, Stem Cell Production Center, İstanbul, Turkey
3Altınbaş University Faculty of Medicine, Bahçelievler Medical Park Hospital Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
Objective: Objective: Steroid-resistant acute graft-versus-host disease (srAGVHD) is the most important cause of morbidity and mortality after allogeneic stem cell transplantation. There are several treatment methods available, including mesenchymal stem cell (MSC) application. The aim of this study was to evaluate the results of MSC therapy performed in children with srAGVHD.
Materials and Methods: MSC therapy was used in our center between November 2014 and December 2017 for 22 patients who developed srAGVHD. The patients were retrospectively evaluated in terms of treatment response and survival.
Results: After application of MSCs, complete response was obtained in 45.5% of the subjects, partial response was obtained in 13.6%, and no response was obtained in 40.9%. We found that 45.5% of the patients were alive and 54.5% had died and our treatment results were similar to those in the literature. Response to MSC treatment was found to be the only prognostic marker affecting mortality.
Conclusion: MSC application is a treatment method that can be used safely together with other treatment methods in srAGVHD, a condition that has a high mortality rate. There are almost no acute side effects. There are also no serious long-term side effects in the literature. Prospective randomized studies are required to obtain high-quality data.
Keywords: Childhood, Stem cell transplantation, Steroid-resistant acute graft-versus-host disease, Mesenchymal stem cell
Çocukluk Çağı Steroid Dirençli Akut Graft Versus-Host Hastalığında Allojenik Mezenkimal Kök Hücre Kullanımı: Retrospektif Bir Çalışma, Tek Merkez DeneyimiCeyhun Bozkurt1, Erdal Karaöz2, Başak Adaklı Aksoy1, Selime Aydoğdu3, Tunç Fışgın31İstinye University Faculty of Medicine, Department of Pediatrics, İstanbul, Turkey; Altınbaş University Faculty of Medicine, Bahçelievler Medical Park Hospital Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
2İstinye University Faculty of Medicine, Department of Histology-Embryology, İstanbul, Turkey; İstinye University Faculty of Medicine, Stem Cell and Tissue Engineering Research and Application Center, İstanbul, Turkey; Liv Hospital, Regenerative Medicine, Stem Cell Production Center, İstanbul, Turkey
3Altınbaş University Faculty of Medicine, Bahçelievler Medical Park Hospital Pediatric Bone Marrow Transplantation Unit, İstanbul, Turkey
Amaç: Amaç: Steroid dirençli akut graft versus host hastalığı (sdAGVHH), allojenik kök hücre naklinden sonra en önemli morbidite ve mortalite nedenidir. Mezenkimal kök hücre (MKH) uygulaması da dahil olmak üzere çeşitli tedavi yöntemleri mevcuttur. Bu çalışmanın amacı, sdAGVHH’li çocuklarda yapılan MKH tedavisi sonuçlarını değerlendirmektir.
Gereç ve Yöntem: Merkezimizde sdAGVHH gelişen 22 hasta için Kasım 2014 - Aralık 2017 tarihleri arasında MKH tedavisi uygulandı. Hastalar tedaviye yanıt ve sağkalım yönünden retrospektif olarak değerlendirildi..
Bulgular: MKH uygulanmasından sonra, deneklerin %45,5’inde tam cevap, %13,6’sında kısmi yanıt alınmıştır. Deneklerin %40,9’unda yanıt alınamamıştır. Hastaların %45,5’inin hayatta olduğunu ve %54,5’inin öldüğünü ve tedavi sonuçlarımızın literatürle benzer olduğunu bulduk. MKH tedavisine yanıt mortaliteyi etkileyen tek prognostik belirteç olarak bulundu.
Sonuç: MKH uygulaması, mortalite oranı yüksek bir durum olan sdAGVHH’de diğer tedavi yöntemleriyle birlikte güvenle kullanılabilecek bir tedavi yöntemidir. Neredeyse hiçbir akut yan etkisi yoktur. Ayrıca literatürde uzun vadeli ciddi bir yan etkisi yoktur. Prospektif randomize çalışmalar, yüksek kaliteli veri elde etmek için gereklidir
Anahtar Kelimeler: Çocukluk çağı, Kök hücre nakli, Steroid dirençli akut graft versus host hastalığı, Mezenkimal kök hücre
Ceyhun Bozkurt, Erdal Karaöz, Başak Adaklı Aksoy, Selime Aydoğdu, Tunç Fışgın. The Use of Allogeneic Mesenchymal Stem Cells in Childhood Steroid-Resistant Acute Graft-Versus-Host Disease: A Retrospective Study of a Single-Center Experience. Turk J Hematol. 2019; 36(3): 186-192
Corresponding Author: Ceyhun Bozkurt, Türkiye |
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