Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease

Newswise — BACKGROUND

Stem cell transplantation is a promising therapeutic option for curing perianal fistula in Crohn’s disease (CD). Anti-tumor necrotic factor (TNF) therapy combined with drainage procedure is effective as well. However, previous studies are limited to proving whether the combination treatment of biologics and stem cell transplantation improves the effect of fistula closure.

AIM

This study aimed to evaluate the long-term outcomes of stem cell transplantation and compare Crohn’s perianal fistula (CPF) closure rates after stem cell transplantation with and without anti-TNF therapy, and to identify the factors affecting CPF closure and recurrence.

METHODS

The patients with CD who underwent stem cell transplantation for treating perianal fistula in our institution between Jun 2014 and December 2022 were enrolled. Clinical data were compared according to anti-TNF therapy and CPF closure.

RESULTS

A total of 65 patients were included. The median age of females was 26 years (range: 21-31) and that of males was 29 (44.6%). The mean follow-up duration was 65.88 ± 32.65 months, and complete closure was observed in 50 (76.9%) patients. The closure rates were similar after stem cell transplantation with and without anti-TNF therapy (66.7% vs 81.6% at 3 year, P = 0.098). The patients with fistula closure had short fistulous tract and infrequent proctitis and anorectal stricture (P = 0.027, 0.002, and 0.008, respectively). Clinical factors such as complexity, number of fistulas, presence of concurrent abscess, and medication were not significant for closure. The cumulative 1-, 2-, and 3-year closure rates were 66.2%, 73.8%, and 75.4%, respectively.

CONCLUSION

Anti-TNF therapy does not increase CPF closure rates in patients with stem cell transplantation. However, both refractory and non-refractory CPF have similar closure rates after additional anti-TNF therapy. Fistulous tract length, proctitis, and anal stricture are risk factors for non-closure in patients with CPF after stem cell transplantation.

Core Tip: This study examined the closure rates of Crohn’s perianal fistula (CPF) in patients undergoing stem cell transplantation for treatment. The complete closure was observed in 76.9% of cases, with similar closure rates after stem cell transplantation with and without anti-tumor necrotic factor (TNF) therapy. Factors associated with higher closure rates included shorter fistulous tracts and the absence of proctitis and anorectal stricture. Clinical factors such as complexity, number of fistulas, concurrent abscess presence, and medication did not significantly affect closure. The cumulative 1-, 2-, and 3-year closure rates were 66.2%, 73.8%, and 75.4%, respectively, suggesting that anti-TNF therapy did not increase CPF closure rates.

• Citation: Park MY, Yoon YS, Park JH, Lee JL, Yu CS. Long-term outcome of stem cell transplantation with and without anti-tumor necrotic factor therapy in perianal fistula with Crohn’s disease. World J Stem Cells 2024; 16(3): 257-266
• URL: https://www.wjgnet.com/1948-0210/full/v16/i3/257.htm
• DOI: https://dx.doi.org/10.4252/wjsc.v16.i3.257