Igor Stoma, Igor Karpov, Svetlana Krivenko, Igor Iskrov, Natalia Milanovich, Alla Koritko and Anatoly Uss
Background: The role of MSCs in infection prevention and treatment is still discussed in transplant and hematological patients. The spectrum and risk factors for infections after MSCs transplantation in patients with GVHD have not been studied before.
Objective: to determine the risk factors and characteristics of infectious complications in patients received mesenchymal stem cell transplantation as a treatment for GVHD.
Methods: A prospective observational study was performed to evaluate the risk factors and characteristics of infectious complications after MSCs transplantation in adult patients having GVHD. Forty episodes of MSCs transplantation in patients with GVHD after allogeneic HSCT were enrolled in the study. MSCs were given at a median dose of 1.44 (interquartile range 1.02-1.97) mln cells/kg per infusion at 76 days (interquartile range 34- 185 days) after HSCT. Data relating to age, gender, date and type of transplantation, characteristics of MSCs, infectious agents and antimicrobial therapy and prevention regimens were prospectively collected in all of the enrolled patients. The episode of proven infectious complication after MSCs transplantation was set as a primary outcome.
Results: There were totally 40 cases of MSCs transplantation in patients with acute or chronic GVHD. Among the registered infectious episodes were viral infections (CMV-associated disease, EBV-associated disease), invasive pulmonary aspergillosis, bacterial bloodstream infections and pneumonia. Progression of main disease was shown to be a risk factor for developing aspergillosis and HSCT from unrelated donor recently was main independent risk factor for bacterial infectious complications. Patients with acute form of GVHD showed a trend to have an increased risk of developing CMV-disease. Cryopreservation of MSCs has shown no significant impact on risk of infections after MSC transplantation.
Conclusion: Viral infections (CMV-disease, EBV-viremia), invasive pulmonary aspergillosis, bacterial bloodstream infections and pneumonia are common complications in adult patients received MSCs transplantation due to GVHD. Risk factor for invasive pulmonary aspergillosis is progression of main disease, and unrelated HSCT mainly increases risk of bacterial infectious complications after MSC transplantation in patients with GVHD, while cryopreservation of MSCs has shown no significant impact on risk of infections after MSC transplantation.View pdf