Abatacept-based Graft-Versus-Host-Disease Prophylaxis in Haplo-identical Hematopoietic Cell Transplant: Single Center Experience in a High-Risk Cohort
Bibliographic record
Abstract
Post-transplant cyclophosphamide (PTCy) has become the most popular approach in haplo-identical hematopoietic cell transplant (haplo-HCT). Although there are reports of a small number of adult patients in the literature who experienced graft failure and were re-transplanted with a haploidentical donor with PTCy prophylaxis, there is still insufficient guidance for patients with specific contraindications/complications to cyclophosphamide and virtually no data in the pediatric setting. Abatacept (Aba), a T cell co-stimulation blockade, has been shown in previous studies to prevent severe acute graft-versus-host disease (GVHD) with minimal toxicity and durable engraftment. We report the efficacy of Aba-based GVHD prophylaxis in four pediatrics patients (ages 2-12 years) who received a haplo-HCT with peripheral blood stem cells (PBSC). Three patients had previous transplants. One patient developed acute GVHD of skin stage 3 and one patient had both stage 3 skin and stage 1 GI acute GVHD. Two patients had mild chronic skin GVHD. All 4 patients are alive with full donor chimerism and without disease at 7-23 months follow up, weaning or off immunosuppressive agents with no complications. Successful haplo-HCT utilizing an Aba- based regimen can result in reliable engraftment and acceptable GVHD. However, our small sample size limits generalizability and encourages the consideration of a larger prospective trial to validate these results in the haplo-HCT setting.
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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 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 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".