BackgroundDespite promising results in preclinical studies, mesenchymal stromal cells (MSCs) face significant challenges in clinical translation. A scoping review by our group highlighted two key issues contributing to this gap: i) the lack of clear and consensus definition for MSCs and ii) under reporting of critical parameters in MSC clinical studies. To address these issues, we conducted a modified Delphi study to establish and implement a consensus definition for MSCs and develop reporting guidelines for MSC clinical studies. MethodsA steering committee of 22 international experts including stakeholders from different MSC research fields participated in the 3 Delphi rounds. For the first round, to obtain a broad perspective, additional investigators recommended by the steering committee were invited to participate. The first 2 rounds consisted of online surveys, while the 3rd round took the form of a virtual meeting. Participants were asked to rate a series of potential defining characteristics of MSCs and items for reporting guidelines. Consensus was defined as at least 80% of the participants rating the item in the same category of importance. ResultsEighty-seven international participants participated in the first-round survey (Spring 2023), 17 participants in the second online survey (Fall 2023) and 15 participants in the final virtual consensus meeting (January 2024). For the MSC definition, 20 items were considered and 9 reached consensus. Items included terminology (1 item), cell marker expression (5 items), tissue origin (1 item), stemness (1 item) and description of critical quality attributes (1 item). For the reporting guidelines, on the 28 initial items and with additional items suggested during round 1, a total of 33 items to report were included. This included items on MSC intervention group and control (i.e., MSC product, dose, and administration, etc.), MSC characteristics (i.e., MSCs provenance, “fitness and viability, immune compatibility, etc.), and MSC culture conditions (i.e., oxygen environment, culture medium, use of serum, etc.). ConclusionBy applying a Delphi method to establish a consensus definition for MSCs and reporting guidelines for MSC-based clinical, this work represents a significant advance in improving transparency and reproducibility in the conduct and reporting of MSC research.