Efficacy of autologous hematopoietic stem cell transplantation in treatment of new onset type 1 diabetes mellitus: a meta-analysis

doi:10.3877/cma.j.issn.1674-0785.2018.08.010

Abstract

Abstract:

Objective

To investigate the efficacy of autologous hematopoietic stem cell transplantation in the treatment of type 1 diabetes mellitus.

Methods

Databases were searched with the terms ′autologous hematopoietic stem cell transplantation′ and ′type 1 diabetes mellitus′. According to the predefined strategy, we performed study screening, data extraction and analysis.

Results

Seven trials met the inclusion criteria (n=112). Meta-analysis showed that glycosylated hemoglobin decreased by 3.32 (95%CI: -4.25 - -2.39; P<0.001) at 12 months after autologous hematopoietic stem cell transplantation. Fasting C-peptide levels increased significantly at 6 and 12 months after autologous hematopoietic stem cell transplantation therapy (MD=0.50, 95%CI: 0.28-0.72, P<0.001; MD=0.48, 95%CI: 0.29-0.67, P<0.001). Approximately 59.4% of patients became free of the need of insulin therapy for different durations.

Conclusion

To a certain extent, autologous hematopoietic stem cell transplantation therapy for type 1 diabetes mellitus can decrease patients′ glycosylated hemoglobin, elevate their fasting C-peptide levels, and make patients become free of the need of insulin therapy for different durations.

Key words: Type 1 diabetes mellitus, Autologous hematopoietic stem cell transplantation, Meta-analysis

Zhiwei Zou, Xiaojun Zhou, Junyu Zhao, Rui Zhang, Chunmei Xu, Qian Zhang, Lin Liao, Jianjun Dong. Efficacy of autologous hematopoietic stem cell transplantation in treatment of new onset type 1 diabetes mellitus: a meta-analysis[J]. Chinese Journal of Clinicians(Electronic Edition), 2018, 12(08): 477-482.

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References 17

1	中华医学会糖尿病学分会. 中国1型糖尿病诊治指南[J]. 糖尿病临床, 2013, 7:6-27.
2	Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes [J]. Lancet, 2014, 383(9911):69-82.
3	Rossini AA. Autoimmune diabetes and the circle of tolerance [J]. Diabetes, 2004, 53(2):267-275.
4	Herold KC, Vignali DA, Cooke A, et al. Type 1 diabetes: translating mechanistic observations into effective clinical outcomes [J]. Nat Rev Immunol, 2013, 13(4):243-256.
5	Astorri E, Fiorina P, Gavaruzzi G, et al. Left ventricular function in insulin-dependent and in non-insulin-dependent diabetic patients: radionuclide assessment [J]. Cardiology, 1997, 88(2):152-155.
6	Shah SC, Malone JI, Simpson NE. A randomized trial of intensive insulin therapy in newly diagnosed insulin-dependent diabetes mellitus [J]. N Engl J Med, 1989, 320(9):550-554.
7	Burt RK, Arnold R, Emmons R, et al. Stem cell therapy for autoimmune disease: overview of concepts from the Snowbird 2002 tolerance and tissue regeneration meeting [J]. Bone marrow transplant, 2003, 32 suppl 1:S3-5.
8	Tapprich C, Fenk R, Schneider P, et al. Early recurrence of rheumatoid arthritis after nonmyeloablative allogeneic blood stem cell transplantation in a patient with multiple myeloma [J]. Bone marrow transplant, 2003, 32(6):629-631.
9	Tyndall A, Fassas A, Passweg J, et al.Autologous haematopoietic stem cell transplants for autoimmune disease-feasibility and transplant-related mortality [J]. Bone Marrow Transplant, 1999, 24(7):729-734.
10	Voltarelli JC, Couri CE, Stracieri AB, et al. Autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus [J]. JAMA, 2007, 297(14):1568-1576.
11	冯凯，许怡薇，叶扶光, 等. 自体外周血造血干细胞移植治疗1型糖尿病的临床观察[J].中华医学杂志, 2011, 91(28):1966-1969.
12	Zhang X, Ye L, Hu J, et al. Acute response of peripheral blood cell to autologous hematopoietic stem cell transplantation in type 1 diabetic patient [J]. PLoS one, 2012, 7(2):e31887.
13	王柏凯，高捷，张娟娟, 等. 1型糖尿病患者在自体造血干细胞移植和传统胰岛素注射治疗后的动态血糖监测比较[J].上海医学, 2013, 36(5):394-397.
14	侯韬，石远凯. 自体造血干细胞移植对1型糖尿病患者血糖控制作用的对照研究[J].中国现代医生, 2014, 52(26):34-37.
15	Gu Y, Gong C, Peng X, et al. Autologous hematopoietic stem cell transplantation and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes: long term follow-up [J]. Chin Med J (Engl), 2014, 127(14):2618-2622.
16	Snarski E, Milczarczyk A, Hałaburda K, et al. Immunoablation and autologous hematopoietic stem cell transplantation in the treatment of new-onset type 1 diabetes mellitus: long-term observations [J]. Bone marrow transplant, 2016, 51(3):398-402.
17	Couri CE, Oliveira MC, Stracieri AB, et al. C-peptide levels and insulin independence following autologous nonmyeloablative hematopoietic stem cell transplantation in newly diagnosed type 1 diabetes mellitus [J]. JAMA, 2009, 301(15):1573-1579.

第一作者	年份	国家	患者人数［例（男性患者比例）］	年龄（岁，均数）	体质量指数（Kg/m²，均数）	T1DM病程	细胞来源	治疗干细胞数量（×10⁶）
Voltarelli^[10]	2007	巴西	15（73.3%）	19.2	19.8	38.4 d（均数）	CD34^＋	11.0
冯凯^[11]	2011	中国	16（43.8%）	13	未提及	未提及	CD34^＋	5.1
Zhang^[12]	2012	中国	9（55.6%）	17.6	18.5	2.0个月（均数）	CD34^＋	12.3
王柏凯^[13]	2013	中国	22（45.5%）	18.0	17.48	<6个月（均数）	未提及	未提及
侯韬^[14]	2014	中国	15（53.3%）	18.95	18.22	4.22个月（均数）	CD34^＋	3.0
Gu^[15]	2014	中国	14（35.7%）	8.08	16.31	未提及	CD34^＋	未提及
Snarski^[16]	2016	波兰	24（70.8%）	24.8	22.45	61 d（中位数）	CD34^＋	4.19

第一作者	年份	国家	患者人数［例（男性患者比例）］	年龄（岁，均数）	体质量指数（Kg/m²，均数）	T1DM病程	细胞来源	治疗干细胞数量（×10⁶）
Voltarelli^[10]	2007	巴西	15（73.3%）	19.2	19.8	38.4 d（均数）	CD34^＋	11.0
冯凯^[11]	2011	中国	16（43.8%）	13	未提及	未提及	CD34^＋	5.1
Zhang^[12]	2012	中国	9（55.6%）	17.6	18.5	2.0个月（均数）	CD34^＋	12.3
王柏凯^[13]	2013	中国	22（45.5%）	18.0	17.48	<6个月（均数）	未提及	未提及
侯韬^[14]	2014	中国	15（53.3%）	18.95	18.22	4.22个月（均数）	CD34^＋	3.0
Gu^[15]	2014	中国	14（35.7%）	8.08	16.31	未提及	CD34^＋	未提及
Snarski^[16]	2016	波兰	24（70.8%）	24.8	22.45	61 d（中位数）	CD34^＋	4.19

第一作者	年份	患者数量	治疗前胰岛素用量（均数）	胰岛素脱离［例（%）］	胰岛素脱离时间（月）	随访时间（月）
Voltarelli^[10]	2007	15	0.38 IU/Kg	14（93.3）	15.9（均数）	18.8（均数）
冯凯^[11]	2011	16	28.2 IU/d	12（75.0）	6（均数）	7（中位数）
Zhang^[12]	2012	9	0.63 IU/Kg	6（66.7）	12（均数）	12（均数）
侯韬^[14]	2014	15	30.22 IU/d	2（13.3）	未提及	>12
Gu^[15]	2014	14	0.53 IU/Kg	3（21.4）	3（中位数）	50.4（均数）
Snarski^[16]	2016	24	0.34 IU/Kg	20（87.0）	31（中位数）	52（中位数）

第一作者	年份	患者数量	治疗前胰岛素用量（均数）	胰岛素脱离［例（%）］	胰岛素脱离时间（月）	随访时间（月）
Voltarelli^[10]	2007	15	0.38 IU/Kg	14（93.3）	15.9（均数）	18.8（均数）
冯凯^[11]	2011	16	28.2 IU/d	12（75.0）	6（均数）	7（中位数）
Zhang^[12]	2012	9	0.63 IU/Kg	6（66.7）	12（均数）	12（均数）
侯韬^[14]	2014	15	30.22 IU/d	2（13.3）	未提及	>12
Gu^[15]	2014	14	0.53 IU/Kg	3（21.4）	3（中位数）	50.4（均数）
Snarski^[16]	2016	24	0.34 IU/Kg	20（87.0）	31（中位数）	52（中位数）

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