Hematopoietic stem cell translation for relapse of psoriasis. Systematic review

Abstract

Psoriasis is a chronic, systemic, autoimmune disease with a high rate of progression and relapse, making treatment a challenge and requiring new therapeutic options. Hematopoietic stem cell transplantation (HSCT) is a promising therapeutic modality for hematological malignancies. Several clinical cases have found that psoriasis in patients with hematological tumor was effectively controlled after HSCT and did not have experienced recurrence during follow-up. HSCT shows considerable promise in the treatment of psoriasis and prevention of its recurrence because of its potential immunomodulatory activity. Therefore, we evaluated the efficacy of HSCT in patients with psoriasis through a systematic literature review (SLR). We systematically searched the PubMed, the Cochrane Library, Web of Science (WOS), China National Knowledge Infrastructure (CNKI) and Wanfang databases to identify studies published before May 31, 2023. All types of clinical studies were considered: patients ≥ 12 years old with hematologic malignancies and psoriasis undergoing HSCT therapy. We included studies if they reported on the outcomes of interest. Exclusion criteria: animal models, human mesenchymal stem cells (hMSC) transplants, narrative reviews, letters to the editor. MeSH and “Key word” terms were used. The level of evidence and the quality rating were rated Joanna Briggs Institute (JBI) lists. We initially identified 90 articles, of which 20 were finally included (1 case series and 19 case reports). These twenty articles included 41 patients (33 male and 8 female, age range 12–67 years). The level of evidence was mostly 4 (JBI); the quality of evidence was met (≥ 50% of JBI items). The primary outcome indicator was psoriasis recurrence in patients during the follow-up time of each study. We performed subgroup analyses of the resulting data according to type of HSCT (autologous or allogeneic transplantation), and whether or not treatment for GVHD was administered after transplantation. Synthesis without meta-analysis items (SWiM) showed that recurrence of psoriasis (and/or psoriatic arthritis) during follow-up was the primary outcome of interest. Overall, a total of 31 (75.6%) of the 41 patients included in our review did not experience recurrence during follow-up period, with a maximum follow-up of 264 months (22 years) and a minimum of 5 months. The remaining 10 patients (24.4%) experienced recurrence of psoriasis during post-transplantation follow-up, with the earliest recurrence of skin lesions occurring at 1.4 months after transplantation but the lesions disappearing at 3.5 months; and the latest recurrence occurred up to 60 months post-transplant, while the patient experienced a flare-up of psoriatic arthritis at 156 mouths, but the severity and duration of psoriasis and arthritis improved compared to pretransplant. HSCT is expected to be an effective treatment for psoriasis as well as recurrence for a wide range of psoriasis patients. Future better epidemiological designs and in-depth studies are needed to evaluate and clarify the benefits of HSCT in psoriasis. Retrospective uncontrolled study, small sample size, with some incomplete data.