Treatment with mesenchymal stromal cells does not improve long-term survival in patients with severe acute GVHD

Abstract

In this study we evaluate the use of mesenchymal stromal cells (MSC) at our centre as treatment for severe acute graft-versus-host disease (GVHD) after allogeneic hematopoietic stem-cell transplantation (HSCT). The primary endpoint was death by any cause. Between October 2001 and August 2006, 22 patients received MSC as treatment for grade II (n = 3), grade III (n = 14) or grade IV (n = 5) acute GVHD. The control patient group consisted of all patients with severe acute GVHD during the same period of time who were not given MSC (n = 30). There were no significant differences in patient and donor characteristics between these two groups. The overall survival 100 days, one and two years after GVHD diagnosis was 68%, 41% and 23% for the study patients and 47%, 30% and 23% for the controls (p = 0.6). Median survival after GVHD diagnosis was 175 days (18–1856) and 80 days (3–2107) (p = 0.09) for the study and control group, respectively. No effect of number of MSC doses was found. Causes of death in the study group were relapse 1 (5%), GVHD 10 (45%), infection 7 (32%) and in the controls relapse 3 (10%), GVHD 16 (53%) and, infection 2 (7%). The cost for the first year after HSCT was evaluated. There was a trend (p = 0.06) for a higher 1-year cost for the study group compared to the controls, 179 k€ compared to 149 k€. In conclusion, we found that treatment of severe GVHD with MSC may prolong initial survival but there was no difference in survival two years after GVHD diagnosis. The use of MSC may also increase the costs.