Abstract:

BACKGROUND: The immunomodulatory ability of bone marrow mesenchymal stem cells (BMSCs) gives it a promising future in treating graft-versus-host disease (GVHD), especially with previous success in treating patients with acute GVHD. However, there are fewer reports concerning BMSCs in treating chronic GVHD, particularly for sclerodermatous chronic graft-versus-host disease (ScGVHD).

OBJECTIVE: To evaluate the efficacy and safety of treatment of BMSCs for ScGVHD, and to primarily explore the immunological mechanism of clinical efficacy.

METHODS: Four ScGVHD patients at the Affiliated Hospital of Academy of Military Medicine Science, between September 2006 and August 2008, were enrolled for this trial. The median patient age was 41 years, 1 female and 3 male. The patients received BMSCs infusion at a dose of (1.0-2.0)×10⁷ cells every time by intrabone marrow injection from the anterosuperior iliac spine and BMSCs from the same donor for the same patient were infused more than once. Concomitant medications for ScGVHD were individualized for each patient, but all were current standard medicines and the doses were significantly tapered.

RESULTS AND CONCLUTION: After BMSCs infusion, the ratio of Th1 to Th2 was dramatically overturned, with an increase of Th1 and a decrease of Th2 reaching at a new balance. Correspondingly, symptoms of all the four patients gradually improved. During the course of BMSCs treatment, the life signs and laboratory results from the recipients remained normal. By the time of this report, there has been no recurrence of leukemia in the four patients. Although this study alone cannot guarantee the application of BMSCs in ScGVHD, the results are strongly in favor of the idea that the BMSCs treatment for ScGVHD patients is therapeutically practical without any detectable side effects, which may provide a new insight into the matter of treating ScGVHD clinically, thus will greatly increase the survival rate of leukemia after allogeneic bone marrow transplantation.