Stem Cell Transplantation Therapy in Systemic Sclerosis: A Systematic Review

Arif Rachman; Prihati Pujowaskito; Arfiyanti Arfiyanti; Arya Duta Dharma; Dinda Puspa; Jafar Elyas; Ilham Syahputro; Nuzuludz Dzikra; Nabil Ramaseno; Ni Made Ayu Widiyasih; Muhammad Zhafran Maulana; Shalya Regita; Ruth Je Deborah Octavia

doi:10.47353/ajmpm.v2i1.20

Authors

Arif Rachman Department of Cell Biology and Biomolecular, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Prihati Pujowaskito Department of Cardiology and Vascular Medicine, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Arfiyanti Department of Nutrition, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Arya Duta Dharma Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Dinda Puspa Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Jafar Elyas Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Ilham Syahputro Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Nuzuludz Dzikra Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Nabil Ramaseno Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Ni Made Ayu Widiyasih Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Muhammad Zhafran Maulana Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Shalya Regita Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia
Ruth Je Deborah Octavia Medical Study Program, Faculty of Medicine, Indonesian Defense University, Bogor, Indonesia

DOI:

https://doi.org/10.47353/ajmpm.v2i1.20

Keywords:

systemic sclerosis, hematopoietic stem cell transplantation, autologous transplantation, cyclophosphamide, systematic review, skin fibrosis

Abstract

Background: Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by systemic inflammation, vascular dysfunction, progressive fibrosis, multiorgan involvement, and impaired quality of life. Autologous hematopoietic stem cell transplantation (HSCT) has been investigated as an option for patients with severe SSc who respond inadequately to conventional immunosuppressive therapy.

Methods: A systematic search was conducted in the Cochrane Library and PubMed using terms related to stem cell transplantation, hematopoietic stem cell transplantation, systemic sclerosis, stem cell therapy, immunomodulatory therapy, and cyclophosphamide. Eligible studies were randomized controlled trials involving adults with diffuse or limited SSc, autologous HSCT as the intervention, and cyclophosphamide or other immunomodulatory therapy as the comparator. Study selection, data extraction, and risk-of-bias assessment were performed systematically, and the selection process was documented using a PRISMA flow diagram.

Discussion: Three randomized controlled trials involving 250 participants were included. Selective non-myeloablative HSCT improved event-free survival, while selective myeloablative HSCT showed benefits in survival analysis and skin-related outcomes. Quality-of-life improvements were reported with selective HSCT approaches. However, HSCT was associated with a higher risk of serious adverse events than cyclophosphamide.

Conclusion: Autologous HSCT may provide clinical benefit in selected patients with severe SSc, but careful risk-benefit assessment, strict patient selection, and long-term monitoring are essential.

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References

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