Efficacy and safety of mesenchymal stem cells co-infusion in allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis.
Efficacy and safety of mesenchymal stem cells co-infusion in allogeneic hematopoietic stem cell transplantation: a systematic review and meta-analysis.
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DOI：
10.1186/s13287-021-02304-x
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发表时间：
2021-04-20
影响因子：
7.5
通讯作者：
Wang L
中科院分区：
文献类型：
--
作者：
Li T;Luo C;Zhang J;Wei L;Sun W;Xie Q;Liu Y;Zhao Y;Xu S;Wang L
异基因造血干细胞移植(allo-HSCT)是治疗严重血液病的救命手段。然而，它的结果还需要进一步改善，骨髓间充质干细胞(MSCs)的联合输注可能会显示出希望。关于这一主题的研究越来越多，尽管不同试验的结果相互矛盾。需要一项系统的综述和荟萃分析来评估骨髓间充质干细胞联合移植在异基因造血干细胞移植中的真正疗效和安全性。从最初到2020年6月10日，在六个医学数据库中搜索了比较allo-HSCT中MSC联合移植和单独进行allo-HSCT的研究。主要结果是植入和移植物抗宿主病(分别为aGVHD和cGVHD)。其他结果包括总存活率(OS)、复发率(RR)、非复发死亡率(NRM)和免疫重建。信息是由两名调查人员独立提取的。使用Cochrane协作工具评估方法质量。用Revman 5.4软件进行Meta分析。纳入6个随机对照试验(RCT)和13个非随机对照试验(NRCT)。骨髓间充质干细胞联合输注可缩短中性粒细胞植入时间(RCT：标准平均差− 1.2 0，p= 0.0 4；nRCT：标准平均差− 0.5 4，p= 0.0 4)和血小板植入(RCT：标准平均差− 0.60，p= 0.0 4；nRCT：SMD− 0.70，p= 0.0 1)，cGVHD的风险较低(RCT：风险比(RR)0.53，p= 0.0 1；nRCT：RR 0.50，p=Lt； (0.01)，以及在不影响RR和OS的情况下，降低aGVHD和NRM风险的略有积极的趋势。亚组分析显示，当MSCs联合移植时，儿童和青少年以及接受人类白细胞抗原(HLA)不相合的HSCT的患者的植入和GVHD和NRM的发生率有所改善；成人和接受HLA相合的HSCT的患者cGVHD较低；恶性肿瘤患者的GVHD和NRM的发生率有所改善；非恶性肿瘤患者的植入速度加快。值得注意的是，在接受人类白细胞抗原相合的HSCT的恶性血液病患者中观察到OS降低。在不增加死亡率或复发的情况下，联合输注MSC通常可以改善植入率，减少cGVHD。对于aGVHD和NRM，MSCs的作用不是很明显。具体地说，我们的数据支持骨髓间充质干细胞联合移植在接受HLA相合的HSCT的儿童和年轻个体中的应用，但不支持在接受HLA相合的HSCT的血液系统恶性肿瘤成人患者中使用。
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is life-saving for severe hematological conditions. However, its outcomes need further improvement, and co-infusion of mesenchymal stem cells (MSCs) may show promise. A growing body of research on this subject exists, while the results of different trials are conflicting. A systematic review and meta-analysis is needed to appraise the real efficacy and safety of MSC co-transplantation in allo-HSCT. Studies comparing MSC co-transplantation in allo-HSCT with allo-HSCT alone were searched in six medical databases from inception to June 10, 2020. The primary outcomes were engraftment and graft-versus-host disease (aGVHD and cGVHD, respectively). Other outcomes included overall survival (OS), relapse rate (RR), non-relapse mortality (NRM), and immune reconstitution. Information was independently extracted by two investigators. Methodological quality was assessed using the Cochrane Collaboration tool. Meta-analysis was performed using RevMan 5.4. Six randomized controlled trials (RCTs) and 13 non-randomized controlled trials (nRCTs) were included. MSC co-infusion resulted in shorter times to neutrophil engraftment (RCTs: standardized mean difference (SMD) − 1.20, p = 0.04; nRCTs: SMD − 0.54, p = 0.04) and platelet engraftment (RCTs: SMD − 0.60, p = 0.04; nRCTs: SMD − 0.70, p = 0.01), a lower risk of cGVHD (RCTs: risk ratio (RR) 0.53, p = 0.01; nRCTs: RR 0.50, p < 0.01), and a slightly positive trend towards reducing the risk of aGVHD and NRM, without affecting RR and OS. Subgroup analyses revealed that when MSCs were co-transplanted, children and adolescents, and patients receiving human leukocyte antigen (HLA)-nonidentical HSCT showed improvements in engraftment and incidence of GVHD and NRM; adults and patients who received HLA-identical HSCT had lower cGVHD; patients with malignancies exhibited improvements in GVHD and NRM incidence; and patients with non-malignancies experienced accelerated engraftment. Notably, a reduced OS was observed in patients with hematological malignancies undergoing HLA-identical HSCT. MSC co-infusion generally improved engraftment and reduced cGVHD, without increasing mortality or relapse. Regarding aGVHD and NRM, the effects of MSCs were not quite significant. Specifically, our data support the utilization of MSC co-transplantation in children and young individuals with HLA-nonidentical HSCT, but not in adult patients with hematological malignancies undergoing HLA-identical HSCT.
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影响因子：
23.9
作者：
Caplan AI;Correa D
通讯作者：
Correa D
影响因子：
7
作者：
Huedo-Medina, Tania B.;Sanchez-Meca, Julio;Botella, Juan
通讯作者：
Botella, Juan
影响因子：
7.5
作者：
Harman RM;Patel RS;Fan JC;Park JE;Rosenberg BR;Van de Walle GR
通讯作者：
Van de Walle GR
影响因子：
11.4
作者：
Cho, B-S;Min, C-K;Kim, C-C
通讯作者：
Kim, C-C
DOI：
10.1186/1478-811x-9-12
发表时间：
2011-05-14
期刊：
Cell communication and signaling : CCS
影响因子：
--
作者：
Hass R;Kasper C;Böhm S;Jacobs R
通讯作者：
Jacobs R