Department of Hematology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510623, Guangdong, China.
Stem Cell Res Ther. 2022 Jun 28;13(1):277. doi: 10.1186/s13287-022-02960-7.
Hematopoietic stem cell transplantation (HSCT) is a standard therapy strategy for most malignant disorders in children. However, transplant-related pneumonia remains a major therapy challenge and mesenchymal stromal cells (MSCs) are rarely reported in HSCT-related pneumonia. The aim of our study was to assess the efficacy of MSC for HSCT-related pneumonia in children.
We retrospectively retrieved HSCT-related (severe and non-severe) pneumonia cases (aged < 18 years), which underwent MSC treatment (MSC group) or non-MSC treatment (non-MSC group) in Guangzhou Women and Children's Medical Center, from December 2017 to December 2019. We investigated outcomes of the two different treatments among severe cases and non-severe cases, respectively. The primary endpoints were differences in overall cure rate and time to cure between MSC and non-MSC groups. The secondary endpoints were 180-day overall survival and cumulative cure rate.
Finally, 31 severe pneumonia cases (16 in MSC group, 15 in non-MSC group) and 76 non-severe cases (31 in MSC group, 45 in non-MSC group) were enrolled in this study. Among severe pneumonia cases, overall cure rate in MSC group was significant higher than that in non-MSC group (12[75.0%] vs. 5[33.3%]; OR = 6.00, 95% CI [1.26-28.5]; p = 0.020); the time (days) to cure in MSC group was dramatically reduced compared with that in non-MSC group (36 [19-52] vs. 62 [42-81]; OR = 0.32, 95% CI [0.12-0.88]; p = 0.009); the 180-day overall survival in MSC group was better than that in non-MSC group (74.5% [45.4-89.6] vs. 33.3% [12.2-56.4]; p = 0.013). Among non-severe pneumonia cases, the time (days) to cure in MSC group was notably decreased compared with that in non-MSC group (28 [24-31] vs. 33 [26-39]; OR = 0.31, 95% CI [0.18-0.56]; p = 0.003). Compared with non-MSC group, MSC-treated patients achieved significant improvements of cumulative cure rate not only in severe pneumonia cases (p = 0.027), but also in non-severe cases (p < 0.001).
This study revealed that MSC treatment could contribute to improving outcomes in children with pneumonia post-HSCT, especially in severe cases. These findings suggest MSC treatment as a promising therapy for HSCT-related pneumonia in children.
造血干细胞移植（HSCT）是儿童大多数恶性疾病的标准治疗策略。然而，与移植相关的肺炎仍然是一个主要的治疗挑战，间充质基质细胞（MSCs）在 HSCT 相关肺炎中很少报道。我们的研究目的是评估 MSCs 治疗儿童 HSCT 相关肺炎的疗效。
我们回顾性地检索了 2017 年 12 月至 2019 年在广州妇女儿童医疗中心接受 MSC 治疗（MSC 组）或非 MSC 治疗（非 MSC 组）的 HSCT 相关（严重和非严重）肺炎病例（年龄<18 岁）。我们分别研究了两组中严重病例和非严重病例的治疗结果。主要终点是 MSC 组和非 MSC 组之间总治愈率和治愈时间的差异。次要终点是 180 天总生存率和累积治愈率。
最终，本研究纳入了 31 例严重肺炎病例（MSC 组 16 例，非 MSC 组 15 例）和 76 例非严重肺炎病例（MSC 组 31 例，非 MSC 组 45 例）。在严重肺炎病例中，MSC 组的总治愈率显著高于非 MSC 组（12[75.0%]vs.5[33.3%]；OR=6.00，95%CI[1.26-28.5]；p=0.020）；MSC 组的治愈时间（天）明显短于非 MSC 组（36[19-52]vs.62[42-81]；OR=0.32，95%CI[0.12-0.88]；p=0.009）；MSC 组 180 天总生存率优于非 MSC 组（74.5%[45.4-89.6]vs.33.3%[12.2-56.4]；p=0.013）。在非严重肺炎病例中，MSC 组的治愈时间（天）明显短于非 MSC 组（28[24-31]vs.33[26-39]；OR=0.31，95%CI[0.18-0.56]；p=0.003）。与非 MSC 组相比，MSC 治疗组不仅在严重肺炎病例（p=0.027），而且在非严重肺炎病例（p<0.001）中累积治愈率均有显著提高。
本研究表明，MSC 治疗可改善 HSCT 后儿童肺炎的预后，特别是在严重病例中。这些发现表明 MSC 治疗是儿童 HSCT 相关肺炎有前途的治疗方法。
