Decidua Stromal Cells for Treatment of Steroid-Refractory Graft-Versus-Host Disease

Graft-versus-host disease (GvHD) is a life-threatening complication anda major cause of morbidity and mortality after allogeneic hematopoieticcell transplantation (HSCT). Steroid refractory aGvHD is associatedwith a high mortality rate (up to 80%) despite intensified treatment withother immunosuppressive agents. Placenta-derived decidua stromalcells (DSCs) are a novel therapy for acute GvHD after allogeneic HSCT.DSCs are different from bone marrow and adipose-derived mesenchymalstromal cells in terms of immunosuppressive capacity and some othercharacteristics. To investigate the therapeutic potential of DSCs, thesecells isolated from the term placenta. Nine patients with steroid-refractoryGvHD (2 patients SOS and GvHD) and 1 patient with chronic GvHDreceived DSCs. The dose of infused cells for all of the patients was 1 × 106DSCs/kg. The patients were given 3 (1-8) doses, with a total of 34 infusions.GvHD response in patients as no, partial and complete was 3/2/5respectively. No adverse events related to the treatment were observedin patients. About 1 year after DSC therapy 4 patients were alive. Causesof death in patients were an infection (despite complete response in GI,skin and liver) due to treatment with monoclonal antibodies, sinusoidalobstruction syndrome (SOS) and liver dysfunction. In conclusion, DSCscan be an acceptable treatment for patients with steroid-refractory acuteGvHD and administered safely in these complicated patients but moreprospective clinical trials are needed.

Keywords:

Decidua stromal cells , Graft-versus-host disease , Hematopoietic stem cell transplantation