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The use of mesenchymal stromal cells in steroid-refractory graft-versus-host disease after pediatric hematopoietic stem cell transplantation: a report of the Spanish group of stem cell transplantation (Geth)

Bone Marrow Transplantation volume 60, pages 1672–1674 (2025)Cite this article

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Hematopoietic stem cell transplantation (HSCT) is a key treatment for numerous benign and malignant pediatric diseases. Despite improved outcomes in HLA-mismatched HSCT, Graft-versus-host disease (GvHD) remains a major cause of transplant-related mortality [1]. GvHD is classified into acute (aGvHD) and chronic (cGvHD) based on clinical and pathophysiological features. Corticosteroids are first-line therapy, but although children tend to respond better than adults [2], many require second-line treatments. Ruxolitinib is currently the only FDA-approved second-line therapy for pediatric GvHD [3]. Following this, numerous treatments have been explored, yielding often inconsistent efficacy results [4].

Mesenchymal stromal cells (MSCs) modulate immune responses, promote tissue repair, and inhibit alloreactive T-cell proliferation [5], making them a promising option for treating GvHD. Since their first use in GvHD in 2004 [6], studies suggest favorable responses in the pediatric population [7], despite high variability due to non-standardized protocols in MSCs production and administration.

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Fig. 1: Mesenchymal stromal cells (MSCs) treatment outcomes.

Data availability

Datasets generated and analyzed during the current study are not publicly available due to institutional and ethical restrictions but are available from the corresponding author on reasonable request.

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Acknowledgements

We are indebted to all the patients and families and to the personnel of the hospitals involved in the study for their support and for the data collection.

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Authors and Affiliations

  1. Pediatric Hematology and Oncology Department, La Paz University Hospital, Madrid, Spain

    Carlos Echecopar, David Bueno Sánchez, Yasmina Mozo, Luisa Sisinni & Antonio Pérez-Martínez

  2. Biostatistics Unit, Institute for Health Research (IdiPAZ), Madrid, Spain

    Odelaisy León Triana & Antonio Pérez-Martínez

  3. Pediatric Hematology and Oncology Department, Niño Jesús University Hospital, Madrid, Spain

    Blanca Molina Angulo, Sara Vinagre & Marta González-Vicent

  4. Pediatric Hematology and Oncology Department, Vall d´Hebron University Hospital, Barcelona, Spain

    María Isabel Benitez Carabante & Cristina Díaz de Heredia

  5. Pediatric Hematology and Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain

    Iván López Torija

  6. Pediatric Hematology and Oncology Department, Sant Joan de Deu University Hospital, Barcelona, Spain

    María Trabazo del Castillo & Julia Marsal

  7. Pediatric Hematology and Oncology Department, La Fe University Hospital, Valencia, Spain

    Carolina Fuentes

  8. Pediatric Hematology and Oncology Department, Virgen de la Arrixaca University Clinical Hospital, Murcia, Spain

    Mercedes Plaza

  9. Pediatric Hematology and Oncology Department, Regional University Hospital of Málaga, Málaga, Spain

    Antonia Pascual Martínez

  10. Pediatric Hematology and Oncology Department, University of Navarra Clinic, Pamplona, Spain

    Andrea Urtasun

  11. Pediatric Hematology and Oncology Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain

    Susana Riesco

  12. Pediatric Hematology and Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    Soledad González Muñíz

  13. Pediatric Department, Autonomous University of Madrid, Madrid, Spain

    Antonio Pérez-Martínez

Authors
  1. Carlos Echecopar
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  2. David Bueno Sánchez
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  3. Odelaisy León Triana
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  4. Blanca Molina Angulo
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  5. María Isabel Benitez Carabante
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  6. Iván López Torija
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  7. María Trabazo del Castillo
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  8. Carolina Fuentes
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  9. Mercedes Plaza
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  10. Antonia Pascual Martínez
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  11. Andrea Urtasun
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  12. Susana Riesco
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  13. Soledad González Muñíz
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  14. Yasmina Mozo
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  15. Luisa Sisinni
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  16. Sara Vinagre
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  17. Julia Marsal
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  18. Marta González-Vicent
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  19. Cristina Díaz de Heredia
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  20. Antonio Pérez-Martínez
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Contributions

CE, DBS, BMA, AP-M and CDdH designed and coordinated the study; CE, BMA, MIBC, ILT, MT, CF, MP, APM, AU, SR, YM, LS, SV, JM, MGV and SGM fulfilled the clinical and biological database; OLT made the graphic design and performed the statistical analysis; CE, DBS and AP-M wrote the paper and all authors discussed the results and reviewed the manuscript. All authors contributed to the article and approved the submitted version.

Corresponding author

Correspondence to Antonio Pérez-Martínez.

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Competing interests

The author declares no financial or commercial conflicts of interest related to this work. This study was supported by the National Health Service of Spain and the Carlos III Health Institute (ISCIII).

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Echecopar, C., Bueno Sánchez, D., León Triana, O. et al. The use of mesenchymal stromal cells in steroid-refractory graft-versus-host disease after pediatric hematopoietic stem cell transplantation: a report of the Spanish group of stem cell transplantation (Geth). Bone Marrow Transplant 60, 1672–1674 (2025). https://doi.org/10.1038/s41409-025-02717-9

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