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DOI: 10.1055/a-2063-3673
Stammzelltherapie bei komplexen perianalen Fisteln bei Morbus Crohn: Aktuelle Evidenz und Ausblick
Stem Cell Therapy for Complex Anal Fistula in Crohn`s Disease: Current Evidence and Future PerspectivesZusammenfassung
Trotz Weiterentwicklungen in interdisziplinärer Diagnostik und Therapie stellen komplexe Analfisteln bei Morbus Crohn weiterhin eine Herausforderung für medikamentöse und chirurgische Therapiekonzepte dar. Konventionelle chirurgische Techniken (u. a. Flap, LIFT) sind mit relativ hohen Persistenz- und Rezidivraten vergesellschaftet. Vor diesem Hintergrund zeigen Ergebnisse der Stammzelltherapie eine vielversprechende, sphinkterschonende Therapieoption. Insbesondere die allogene mesenchymale Stammzelltherapie (Darvadstrocel) konnte im Rahmen der randomisierten ADMIRE-CD-Studie eine hohe Wirksamkeit bei komplexen Crohn-Fisteln zeigen, die auch in limitierten „Real-World“-Daten reproduziert werden konnte. Die aktuelle Evidenz der allogenen mesenchymalen Stammzellen hat hierbei auch Einzug in internationale Leitlinien erhalten. Inwieweit die allogene mesenchymale Stammzelltherapie in Zukunft eine effektive Therapieoption im interdisziplinären Management der komplexen perianalen Fistel bei Morbus Crohn darstellt, kann derzeit noch nicht definitiv bewertet werden.
Abstract
Despite progress in multidisciplinary diagnostic and therapeutic strategies, complex anal fistulas associated with Crohn’s disease remain a challenge for both medical and surgical management. Conventional surgical techniques such as flap procedures or LIFT are still associated with considerable persistence and recurrence rates. Based on this background, results of stem cell therapy for Crohn’s anal fistula have shown promising results and are a sphincter-preserving technique. In particular, adipose-derived, allogeneic stem cell therapy (Darvadstrocel) has shown encouraging healing rates within the randomised controlled ADMIRE-CD trial, which were reproducible in “real world” data of limited clinical studies. The current evidence has led to the integration of allogeneic stem cell therapy into international guidelines. To date, the definitive status of allogeneic stem cells in the multidisciplinary treatment algorithm for complex anal fistulas associated with Crohn’s disease cannot be evaluated.
Publikationsverlauf
Eingereicht: 04. März 2023
Angenommen: 25. März 2023
Artikel online veröffentlicht:
02. Juni 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
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