Clinical Efficacy and Safety of Stem Cell-Based Therapy in Treating Asherman Syndrome: A System Review and Meta-Analysis

Yiming Zhao; Qifan Luo; Xiao Zhang; Yafei Qin; Jingpeng Hao; Dejun Kong; Hongda Wang; Guangming Li; Xiangying Gu; Hao Wang

doi:10.1155/2020/8820538

Clinical Efficacy and Safety of Stem Cell-Based Therapy in Treating Asherman Syndrome: A System Review and Meta-Analysis

Stem Cells Int. 2020 Dec 19:2020:8820538. doi: 10.1155/2020/8820538. eCollection 2020.

Authors

Yiming Zhao^{1

2}, Qifan Luo³, Xiao Zhang⁴, Yafei Qin^{1

2}, Jingpeng Hao⁵, Dejun Kong^{1

2}, Hongda Wang^{1

2}, Guangming Li^{1

2}, Xiangying Gu⁶, Hao Wang^{1

2}

Affiliations

¹ Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China.
² Tianjin General Surgery Institute, Tianjin Medical University General Hospital, Tianjin, China.
³ Department of Radiation and Medical Oncology, Zhongnan Hospital of Wuhan University, Wuhan, China.
⁴ Department of Hepatobiliary and Pancreatic Surgery, Henan Provincial People's Hospital, Zhengzhou, China.
⁵ Department of Anorectal Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
⁶ Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China.

Abstract

Asherman's Syndrome (AS) is an uncommon, acquired, and refractory gynecological disorder. Current treatment was still limited, and stem cell-based therapy has been proposed as a novel strategy for management of AS. Here, we conducted a meta-analysis of self-controlled clinical trials to assess the effectiveness and safety of stem cell-based therapy in Asherman syndrome patients who have failed in conventional treatment. We systematically searched PubMed, Embase, Cochrane, and Web of Science database (published up to October 3, 2020). Our main evaluation outcomes were menses improvement, endometrial thickness changes, pregnancy outcome, and side effects. All analyses were performed by using RevMan5.4 software. 427 studies were identified, eight of which were eligible and included in our analysis. Stem cell combined hormone therapy achieved a higher likelihood of improving menstruation (risk ratio [RR] 22.43, 95% CI: 8.03 to 62.68, P < 0.00001), an enhancement of pregnancy outcome (risk ratio [RR] 11.1, 95% CI: 3.58 to 34.38, P < 0.0001), and a mean increase of 3-month endometrial thickness (standardized mean difference [SMD] 2.43, 95% CI: 1.72 to 3.13, P < 0.00001). Subgroup analysis also indicated that 6-month and 9-month endometrial thickness increased significantly with the stem cell-based treatment. Moreover, no obvious and severe adverse reactions were observed during the process of stem cell therapy. There were 3 patients (3.57%) reported with lost appetite, mild gastritis, vomiting, or abdominal cramps, whereas, these symptoms relieved subsequently. This meta-analysis systematically reviewed and synthesized the outcomes of stem cell-based therapy in treating Asherman syndrome, which suggest that stem cell and hormone combination therapy was safe and more effective in improving menstruation duration, pregnancy outcome, and endometrial thickness. However, further trials with large sample sizes are needed to establish more solid evidence for administrating this therapy in clinic.