Adult Bone Marrow Cell Therapy for XXXX : Evidence and Insights From Randomized Controlled Trials.

@entity1 @entity1188 @entity741 @entity583 @entity943 @entity204
RATIONALE: Notwithstanding the uncertainties about the outcomes of bone marrow cell (BMC) therapy for heart repair, further insights are critically needed to improve this promising approach. OBJECTIVE: To delineate the true effect of BMC therapy for cardiac repair and gain insights for future trials through systematic review and meta-analysis of data from eligible randomized controlled trials. METHODS AND RESULTS: Database searches through August 2014 identified 48 eligible randomized controlled trials (enrolling 2602 @entity1 ). Weighted mean differences for changes in left ventricular (LV) ejection fraction, @entity1188 size, LV end-systolic volume, and LV end-diastolic volume were analyzed with random-effects meta-analysis. Compared with standard therapy, BMC transplantation improved LV ejection fraction (2.92%; 95% confidence interval, 1.91-3.92; P<0.00001), reduced @entity1188 size (-2.25%; 95% confidence interval, -3.55 to -0.95; P=0.0007) and LV end-systolic volume (-6.37 mL; 95% confidence interval, -8.95 to -3.80; P<0.00001), and tended to reduce LV end-diastolic volume (-2.26 mL; 95% confidence interval, -4.59 to 0.07; P=0.06). Similar effects were noted when data were analyzed after excluding studies with discrepancies in reporting of outcomes. The benefits also persisted when cardiac catheterization was performed in control @entity1 as well. Although imaging modalities partly influenced the outcomes, LV ejection fraction improved in BMC-treated @entity1 when assessed by magnetic resonance imaging. Early (<48 hours) BMC injection after @entity583 was more effective in reducing @entity1188 size, whereas BMC injection between 3 and 10 days proved superior toward improving systolic function. A minimum of 50 million BMCs seemed to be necessary, with limited additional benefits seen with increasing cell numbers. BMC therapy was safe and improved clinical outcomes, including all-cause mortality, recurrent @entity583 , @entity943 , and cerebrovascular accident during follow-up, albeit with differences between @entity583 and @entity741 subgroups. CONCLUSIONS: Transplantation of adult BMCs improves LV ejection fraction, reduces @entity1188 size, and ameliorates remodeling in @entity1 with @entity741 . These effects are upheld in the analyses of studies using magnetic resonance imaging and also after excluding studies with discrepant reporting of outcomes. BMC transplantation may also reduce the incidence of @entity204 , recurrent @entity583 , @entity943 , and cerebrovascular accident during follow-up.
