A Meta-analysis Of The Efficacy Of Mesenchymal Stem Cells In The Treatment Of Chronic Graft Versus Host Disease

Background:Allogeneic hematopoietic stem cell transplantation(alto--HSCT)is the only method that can cure malignant tumors of the blood system currently.Graft versus host disease(GVHD)is one of the main complications after allogeneic hematopoietic stem cell transplantation,while chronic graft versus host disease(chronic graft versus host disease,CGVHD)is an important factor that seriously affects the quality of life of allogeneic hematopoietic stem cell transplantation patients,and is also the main cause of late death.Therefore,the prevention and treatment of chronic graft-versus-host disease is particularly important.Currently,glucocorticoid-based treatment is still the first-line standard clinical treatment for cGVHD.For hormone-resistant chronic graft-versus-host disease,the exploration of second-line prevention and treatment is inevitable.In recent years,new therapeutic methods such as mesenchymal stem cells,sirolimus,monoclonal antibody,imatinib,and lukotinib have been gradually applied to the treatment of chronic GVHD in the exploration.Mesenchymal stem cells(MSCS)play an important role in second-line control strategies.However,there is controversy in various research centers about whether mesenchymal stem cells are effective in treating chronic graft versus host disease in patients with allogeneic hematopoietic stem cells and whether they increase recurrence and infection.Objective:Computer retrieval Pubmed,medline,Embase,the Cochrane library,ten thousand party,hownet,Chinese biomedical literature database,including mesenchymal stem cells as a second-line treatment for chronic graft versus host disease randomized controlled trials(randomized controlled trials,RCT).according to the inclusion and exclusion standard,after extracting data and quality evaluation,using RvMan5.3 software into the classification of the variable data to odds ratio(odds thewire,Statistical heterogeneity between the included studies were quantitatively determined by I2.When I2<50%,it was considered that there was no significant inter-study heterogeneity.No matter how large the heterogeneity was,the fixed effect model was used.When I2>was 50%,the random effect model was used to analyze the sources of heterogeneity at the same time,and then subgroup analysis and sensitivity analysis were conducted.Results:A total of 461 patients were included in 8 randomized controlled studies.This meta-analysis showed that compared with the control group,the use of mesenchymal stem cells can reduce the cumulative incidence of chronic graft versus host disease[OR=0.47,95%CI(0.30,0.75)P=0.001],suggesting that mesenchymal stem cells reduced the cumulative incidence of chronic graft versus host disease,with statistically significant results.In terms of disease-free survival rate,this meta-analysis suggested that there was no significant difference in disease-free survival rate between the group using mesenchymal stem cells and the control group[OR=0.85,95%ci(0.50,1.46)P=0.56],The results suggested that mesenchymal stem cells could not benefit transplant patients in terms of disease-free survival rate.In terms of infection rate,there was no significant difference between the two groups[OR=1.07,95%ci(0.53,2.17)P=0.85],suggesting that mesenchymal stem cells could not reduce the infection rate of transplant patients.In terms of overall survival rate,there was no significant difference between the experimental group and the control group[OR=1.18,95%ci(0.75,1.84)P=0.47],suggesting that the use of mesenchymal stem cells did not increase the overall survival rate of transplant patients.When it comes to disease recurrence,the results of meta-analysis suggested that there was no statistical significance in the recurrence rate of the two groups[OR=1.3,95%ci(1.75,1.24)P=0.34],suggesting that the use of mesenchymal stem cells would not increase the disease recurrence of the transplant patients..Conclusion:Mesenchymal stem cells can reduce the cumulative incidence of chronic graft versus host disease(GVHD)associated with allogeneic hematopoietic stem cell transplantation without increasing the risk of infection or recurrence,and have no benefit in disease-free survival or overall survival.