Treatment of Steroid-Refractory Acute Graft-Versus-Host Disease Using Commercial Mesenchymal Stem Cell Products

被引:33
作者
Murata, Makoto [1 ]
Teshima, Takanori [2 ]
机构
[1] Nagoya Univ, Dept Hematol & Oncol, Grad Sch Med, Nagoya, Aichi, Japan
[2] Hokkaido Univ, Dept Hematol, Fac Med, Sapporo, Hokkaido, Japan
基金
日本学术振兴会;
关键词
graft-versus-host disease (GVHD); mesenchymal stem cell (MSC); steroid; ruxolitinib; thymoglobulin; RESISTANT ACUTE GVHD; STROMAL CELLS; BONE-MARROW; CORD BLOOD; PEDIATRIC-PATIENTS; IN-VITRO; CORTICOSTEROID-THERAPY; SUCCESSFUL ENGRAFTMENT; GRADE III; PHASE-I;
D O I
10.3389/fimmu.2021.724380
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Acute graft-versus-host disease (GVHD) is a life-threatening complication that can develop after allogeneic hematopoietic stem cell transplantation. In particular, the prognosis of patients with steroid-refractory acute GVHD is extremely poor. Ryoncil (TM) (remestemcel-L), a human bone marrow-derived mesenchymal stem cell (MSC) product, failed to show superiority over placebo in patients with steroid-refractory acute GVHD, but it was approved for use in pediatric patients in Canada and New Zealand based on the results of a subgroup analysis. Temcell(R), an equivalent manufactured MSC product to remestemcel-L, was approved in Japan based on small single-arm studies by using a regulation for regenerative medicine in 2016. The efficacy of Temcell was evaluated in 381 consecutive patients treated with Temcell during the initial 3 years after its approval. Interestingly, its real-world efficacy was found to be equivalent to that observed in a prospective study of remestemcel-L with strict eligibility criteria. In this article, the potential of MSC therapy in the treatment of acute GVHD is discussed. A meticulous comparison of studies of remestemcel-L and Temcell, remestemcel-L/Temcell and ruxolitinib, and remestemcel-L/Temcell and thymoglobulin showed that the precise position of remestemcel-L/Temcell therapy in the treatment of acute GVHD remains to be determined.
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页数:8
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