1. Phase II Trial of Costimulation Blockade With Abatacept for Prevention of Acute GVHD.
- Author
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Norkin, Maxim, Farhadfar, Nosha, Pulsipher, Michael, Shenoy, Shalini, Petrovic, Aleksandra, Schultz, Kirk, Yanik, Gregory, Waller, Edmund, Levine, John, Ferrara, James, Blazar, Bruce, Langston, Amelia, Horan, John, Kean, Leslie, Watkins, Benjamin, Qayed, Muna, McCracken, Courtney, Bratrude, Brandi, Betz, Kayla, Suessmuth, Yvonne, Yu, Alison, Sinclair, Shauna, Furlan, Scott, Bosinger, Steven, Tkachev, Victor, Rhodes, James, Tumlin, Audrey, Narayan, Alexandria, Cribbin, Kayla, Gillespie, Scott, Gooley, Ted, Pasquini, Marcelo, Hebert, Kyle, Kapoor, Urvi, Rogatko, Andre, Tighiouart, Mourad, Kim, Sungjin, Bresee, Catherine, Choi, Sung, Davis, Jeffrey, Duncan, Christine, Giller, Roger, Grimley, Michael, Harris, Andrew, Jacobsohn, David, and Lalefar, Nahal
- Subjects
Abatacept ,Adolescent ,Adult ,Aged ,Child ,Cyclosporine ,Graft vs Host Disease ,Hematopoietic Stem Cell Transplantation ,Humans ,Immunosuppressive Agents ,Male ,Methotrexate ,Middle Aged ,Tacrolimus ,Young Adult - Abstract
PURPOSE: Severe (grade 3-4) acute graft-versus-host disease (AGVHD) is a major cause of death after unrelated-donor (URD) hematopoietic cell transplant (HCT), resulting in particularly high mortality after HLA-mismatched transplantation. There are no approved agents for AGVHD prevention, underscoring the critical unmet need for novel therapeutics. ABA2 was a phase II trial to rigorously assess safety, efficacy, and immunologic effects of adding T-cell costimulation blockade with abatacept to calcineurin inhibitor (CNI)/methotrexate (MTX)-based GVHD prophylaxis, to test whether abatacept could decrease AGVHD. METHODS: ABA2 enrolled adults and children with hematologic malignancies under two strata: a randomized, double-blind, placebo-controlled stratum (8/8-HLA-matched URD), comparing CNI/MTX plus abatacept with CNI/MTX plus placebo, and a single-arm stratum (7/8-HLA-mismatched URD) comparing CNI/MTX plus abatacept versus CNI/MTX CIBMTR controls. The primary end point was day +100 grade 3-4 AGVHD, with day +180 severe-AGVHD-free-survival (SGFS) a key secondary end point. Sample sizes were calculated using a higher type-1 error (0.2) as recommended for phase II trials, and were based on predicting that abatacept would reduce grade 3-4 AGVHD from 20% to 10% (8/8s) and 30% to 10% (7/8s). ABA2 enrolled 142 recipients (8/8s, median follow-up = 716 days) and 43 recipients (7/8s, median follow-up = 708 days). RESULTS: In 8/8s, grade 3-4 AGVHD was 6.8% (abatacept) versus 14.8% (placebo) (P = .13, hazard ratio = 0.45). SGFS was 93.2% (CNI/MTX plus abatacept) versus 82% (CNI/MTX plus placebo, P = .05). In the smaller 7/8 cohort, grade 3-4 AGVHD was 2.3% (CNI/MTX plus abatacept, intention-to-treat population), which compared favorably with a nonrandomized matched cohort of CNI/MTX (30.2%, P < .001), and the SGFS was better (97.7% v 58.7%, P < .001). Immunologic analysis revealed control of T-cell activation in abatacept-treated patients. CONCLUSION: Adding abatacept to URD HCT was safe, reduced AGVHD, and improved SGFS. These results suggest that abatacept may substantially improve AGVHD-related transplant outcomes, with a particularly beneficial impact on HLA-mismatched HCT.
- Published
- 2021