Treatment of posttransplantation diabetes mellitus with anti-CD20 monoclonal antibodies
Bibliographic record
Abstract
Anti-CD20 has been successfully used for the treatment of immune manifestations after HSCT. We report the use of this treatment for post-HSCT diabetes mellitus. An 11-year-old boy received a HSCT from an HLA-identical sibling for AML CR1. Preparative regimen consisted of fractioned TBI and etoposide, along with graft-versus-host prophylaxis of cyclosporin and methotrexate. SCT resulted in full donor engraftment. Cyclosporin was discontinued on day 28 posttransplantation due to renal failure. Subsequently, acute grade III skin GVHD was successfully treated with glucocorticoids, with no glucose intolerance. Glucocorticoids were discontinued at 5 months posttransplantation. At that time, buccal lichen planus was present. No specific treatment was given. At 12 months posttransplantation, the patient developed bronchiolitis obliterans and vitiligo (face, arms, and hips). Prednisone (up to 1 mg/kg/day) was resumed; pulmonary function improved, but skin lesions persisted unchanged. Again, glucocorticoid therapy did not induce glucose intolerance. At 22 months posttransplantation, glucocorticoids were tapered and azathioprine and hydroxychloroquine begun. Mofetylmycofenolate was substituted for azathioprine at 28 months posttransplantation. At 31 months posttransplantation, the patient discontinued all treatment, including glucocorticoids. His condition remained stable thereafter until he developed hypothyroidism at 69 months posttransplantation, treated with L-thyroxine. Antimicrosomal and antithyroglobulin antibodies were negative. At 81 months posstransplantation, the patient experienced polyuria, polydipsia, and major weight loss. Hos blood sugar level was 36 mmol/l (648 mg/dl). He had ketonuria but no ketoacidosis. His HbA1c level was 13.4% (normal, 4.8% to 6.0%). The diagnosis of diabetes mellitus was made. Diabetes was controlled with insulin, 1.1 U/kg/day. Tests for associated autoantibodies were all negative, including anti–glutamic acid decarboxylase (GAD) antibodies. There was no history of diabetes mellitus in the donor or in the more extended family. The patient’s body mass index was in the 72nd percentile. Four doses of weekly intravenous (IV) rituximab(375 mg/m2/dose) were administered, followed by monthly IV gammaglobulins. Insulin was discontinued 3 months after the last dose of rituximab therapy. Four months later, the patient remains free of symptoms and normoglycemic, with an HbA1c level of 6,1%. Although the patient may be experiencing a “honeymoon” phenomenon with spontaneous, transitory remission of diabetes, our experience could also suggest that diabetes mellitus developing after SCT may be of immune origin, and that early treatment with anti-CD20 might modify the course of the disease.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".