Outcomes of Patients Treated With Abatacept for the Prevention of GVHD

Benjamin Watkins, MD, Tulane University School of Medicine, New Orleans, Louisiana, provides the latest research and date including real-world-analyses of patients treated with immunomodulator abatacept for the prevention of graft-versus-host-disease (GVHD).

Transcript:

Hi, my name is Ben Watkins. I'm at Tulane University School of Medicine and today I wanted to talk a little bit about updates in patients treated with abatacept for the prevention of graft-versus-host disease. 

Abatacept is a drug that was approved for the prevention of graft-versus-host disease back in December of 2021, based on a phase 2 trial that showed significant improvements in severe acute graft-versus-host disease and unrelated donor transplant in both mismatched and matched unrelated donors.

Since the FDA approval, new data has come out continuing to show the benefit of abatacept in the prevention of acute graft-versus-host disease. These studies were performed in off-study patients to get a real-world analysis of the impacts of abatacept, and found encouragingly low rates of severe acute graft-versus-host disease.

One of the other things that came out of the ABA2 trial, which was the phase 2 trial that led to the FDA approval, was that while the 4 doses of abatacept given in the first month post-transplant was effective at preventing severe acute graft-versus-host disease, there did not appear to have an impact on chronic graft versus host disease.

Now there are other studies ongoing in both malignant and non-malignant disease evaluating extended dosing abatacept out to 8 doses through day 150 or day 180 post-transplant to see if those additional doses could prevent the chronic graft-versus-host disease. 

In one of these real-world analyses, we looked at specifically pediatric patients to see if the benefit was still there in the prevention of acute graft-versus-host disease. And what we saw was very similar to what was seen on the ABA2 trial, in that we had very low rates of severe acute graft-versus-host disease, as well as encouraging event-free survival and overall survival. We also looked at the older population, those patients that were over the age of 60 and also found encouraging results in the prevention of acute GVHD in the event-free survival. 

The next steps with abatacept is to evaluate whether that extended dosing is going to prevent the chronic graft-versus-host disease. So, in addition to the ABA3 study, which is looking specifically at malignant patients with 8 doses of abatacept, we also have a number of trials looking at non-malignant disease, including sickle cell disease to see if there may be benefit there as well.

Sources:

Raghunandan S, Qayed M, Watkins BK, et al. Abatacept for graft versus host disease prophylaxis in patients 60 years and older receiving mismatched unrelated donor transplantation for hematologic malignancies. Bone Marrow Transplant. Published August 14, 2023. doi:10.1038/s41409-023-02043-y

Raghunandan S, Gorfinkel L, Bratrude B, et al. Abatacept for the prevention of graft versus host disease in pediatric patients receiving 7/8 HLA-mismatched unrelated transplant for hematologic malignancies: a real-world analysis. Bone Marrow Transplant. Published August 14, 2023. doi:10.1038/s41409-023-02034-z

Raghunandan S, Gorfinkel L, Graiser M, et al. Abatacept for the prevention of GVHD in patients receiving mismatched unrelated transplants: a real-world analysis. Blood Adv. Published August 22, 2023. doi:10.1182/bloodadvances.2023010225