Mesenchymal stromal cells (MSCs) are an emerging prophylaxis option for graft-versus-host disease (GVHD) in haplo-identical hematopoietic stem cell transplantation (haplo-HSCT) recipients with severe aplastic anemia (SAA), but studies have reported inconsistent results. This systematic review and meta-analysis evaluates the efficacy of MSCs as prophylaxis for GVHD in SAA patients with haplo-HSCT. Studies were retrieved from PubMed, EMBASE, Cochrane, Web of Science, and http://clinicaltrials.gov from establishment to February 2020. Twenty-nine single-arm studies (n = 1456) were included, in which eight (n = 241) studies combined with MSCs and eleven (n = 1215) reports without MSCs in haplo-HSCT for SAA patients. The primary outcomes were the incidences of GVHD. Other outcomes included 2-year overall survival (OS) and the incidence of cytomegalovirus (CMV) infection. Odds ratios (ORs) were calculated to compare the results pooled through random or fixed effects models. Between MSCs and no MSCs groups, no significant differences were found in the pooled incidences of acute GVHD (56.0%, 95% CI 48.6–63.5% vs. 47.2%, 95% CI 29.0–65.4%; OR 1.43, 95% CI 0.91–2.25; p = 0.123), grade II–IV acute GVHD (29.8%, 95% CI 24.1–35.5% vs. 30.6%, 95% CI 26.6–34.6%; OR 0.97, 95% CI 0.70–1.32; p = 0.889), and chronic GVHD (25.4%, 95% CI 19.8–31.0% vs. 30.0%, 95% CI 23.3–36.6%; OR 0.79, 95% CI 0.56–1.11; p = 0.187). Furtherly, there was no obvious difference in 2-year OS (OR 0.98, 95% CI 0.60–1.61; p = 1.000) and incidence of CMV infection (OR 0.61, 95% CI 0.40–1.92; p = 0.018). Our meta-analysis indicates that the prophylactic use of MSC co-transplantation is not an effective option for SAA patients undergoing haplo-HSCT. Hence, the general co-transplantation of MSCs for SAA haplo-HSCT recipients may lack evidence-based practice.

中文翻译：

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间充质基质细胞可预防患有严重再生障碍性贫血的单倍体相合造血干细胞移植受者的移植物抗宿主病？——系统评价和荟萃分析

间充质基质细胞（MSC）是单倍体相合造血干细胞移植（haplo-HSCT）严重再生障碍性贫血（SAA）受者移植物抗宿主病（GVHD）的新兴预防选择，但研究报告的结果不一致。这项系统评价和荟萃分析评估了 MSC 在单倍体 HSCT 的 SAA 患者中预防 GVHD 的功效。研究检索自 PubMed、EMBASE、Cochrane、Web of Science 和 http://clinicaltrials.gov，从建立到 2020 年 2 月。纳入了 29 项单臂研究 (n = 1456)，其中 8 项 (n = 241) ) 结合 MSC 的研究和 11 项 (n = 1215) 报告在 SAA 患者的单倍体 HSCT 中不使用 MSC。主要结局是 GVHD 的发生率。其他结果包括 2 年总生存率 (OS) 和巨细胞病毒 (CMV) 感染的发生率。计算优势比 (OR) 以比较通过随机或固定效应模型汇总的结果。MSC 组和无 MSC 组之间，急性 GVHD 的汇总发生率没有显着差异（56.0%，95% CI 48.6–63.5% vs. 47.2%，95% CI 29.0–65.4%；OR 1.43，95% CI 0.91 –2.25；p = 0.123），II-IV 级急性 GVHD（29.8%，95% CI 24.1-35.5% vs. 30.6%，95% CI 26.6-34.6%；OR 0.97，95% CI 0.70-1.32；p = 0.889）和慢性 GVHD（25.4%，95% CI 19.8–31.0% vs. 30.0%，95% CI 23.3–36.6%；OR 0.79，95% CI 0.56–1.11；p = 0.187）。此外，2 年 OS（OR 0.98，95% CI 0.60-1.61；p = 1.000）和 CMV 感染发生率（OR 0.61，95% CI 0.40-1.92；p = 0.018）没有明显差异。我们的荟萃分析表明，对于接受单倍体造血干细胞移植的 SAA 患者来说，预防性使用 MSC 联合移植并不是一个有效的选择。因此，针对 SAA 单倍体-HSCT 受者的一般间充质干细胞联合移植可能缺乏循证实践。