| Objective:Through a retrospective case-control study, To observe the clinical efficacy and safety of bone marrow mesenchymal stem cells (MSCs) combined with peripheral blood hematopoietic stem cell transplantation (HSCT) in the treatment of severe hematologic diseases.Methods:Clinical data about 36 patients who undergoing autologous and allogeneic peripheral blood stem cell transplantation in Hematology of the First Affiliated Hospital of Kunming Medical University from February 2012 to January 2015 were summarized. 8 patients who experienced MSCs combined with peripheral blood hematopoietic stem cell as the study group, the other 28 patients with peripheral blood HSCT were treated as control group. The follow-up time was up to December 31,2015. comparison of the engraftment, graft-versus-host disease (GVHD), early and mid-phase infection,overall survival (OS), progression-free survival (PFS) and relapse of two groups. At the same time, Observation of adverse reactions during the infusion of MSCs, including rash, fever, changes in oxygen saturation and other infusion related reactions. Statistics on the above data, combined with the relevant literature to analyze and discuss the the effect of MSCs on HSCT.Results:Overall, only one patient who died of pulmonary fungal infection in the 22 day after transplantation from the control group failed to reach full donor chimeric status. The median time to neutrophil engraftment for study group and control group were 13 days (8-17 days) and 11 days (9-18 days), the difference was statistically insignificant (P=0.061). In addition, the median time to platelet engraftment was comparable (17vs 11 days), the difference was statistically significant (P=0.006). In 23 patients with allogeneic HSCT, the incidence of Ⅰ-Ⅱ degree aGVHD in study group was 28.6%, and none developed Ⅲ-Ⅳ degree aGVHD. the incidence rate of Ⅰ-Ⅱ and Ⅲ-Ⅳ degree aGVHD in control group was 50% and 6.3%, respectively.57.1% of patients in the study group experienced chronic GVHD, including 28.6% limited and 28.6% extensive, compared with 25% of patients in the control group, including 18.7%% limited and 28.6% extensive, the difference was statistically significant (P>0.05). Within 4 months after transplantation,75% of patients in the study group developed severe infection as compared with 46.4% in control group. The infection rates of CMV and EBV in sudy group were 62.5% and 75%, compared with 25% and 35.7% in control group. There was no significant difference between the two groups (P> 0.05). The probability that patients in the study group would attain 1-years OS, PFS and relapse in the MSCs group was 75%, 75% and 0, respectively.The control group was 60.7%,53.6% and 17.9%. There was no significant difference between the two groups (P> 0.05). No significant adverse reactions were observed during MSCs infusion and the observation period.Conclusions:1 Mesenchymal stem cells combined with peripheral blood stem cell transplantation is safe, no acute or chronic toxicity and the recent primary disease recurrence.2 The results of this study showed that the hematopoietic recovery time in MSCs combined with peripheral blood HSCT group was slightly delayed compared with the non MSCs group.Howevere,Difference of transplantation type was obvious and the number of cases is small, more study would be needed.3 The incidence of aGVHD after Mesenchymal stem cells combined with peripheral blood stem cell transplantation was decreased, but the difference was not statistically significant due to the small number of cases, and the effect was still to be further observed.4 MSCs have no effect on Early and mid-phase infection,OS, PFS and relapse in peripheral blood hematopoietic stem cell transplantation. However, due to the small number of cases, its long-term effect is still to be further observed. |
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