Abatacept for Prophylaxis of Acute and Chronic Graft-Versus-Host-Disease in Children Undergoing Allogeneic Hematopoietic Stem Cell Transplantation-A Systematic Review and Meta-Analysis of Cohort Studies.

Background

Graft-versus-host disease (GvHD) remains one of the most significant complications of hematopoietic stem cell transplantation (HSCT). Abatacept, a selective T-cell costimulation modulator, is a relatively novel prophylactic agent, though pediatric data remain limited. PROCEDURE A systematic review and meta-analysis was conducted to evaluate the efficacy and safety of abatacept for GvHD prophylaxis in pediatric HSCT.

Results

Fifteen cohort studies were identified (eight comparative and seven single-arm). Studies included abatacept as adjunctive agent to traditional regimens. Pooled analyses demonstrated that abatacept-inclusive regimens significantly reduced the risk of Grade II-IV acute GvHD (aGvHD) (risk ratio [RR] 0.31, 95% confidence interval [CI] 0.14-0.65) and severe Grade III-IV aGvHD (RR 0.14, 95% CI 0.05-0.37). Abatacept administration was not associated with decreased moderate-to-severe chronic GvHD incidence, although extended regimens were associated with reduced risk (RR 0.25, 95% CI 0.08-0.78). Abatacept-inclusive GvHD prophylaxis was not associated with compromised immune reconstitution or increased viral reactivations, whereas it was associated with a reduced incidence of bacterial infections (RR 0.39, 95% CI 0.21-0.74) and improved overall survival (RR 1.18, 95% CI 1.03-1.34).

Conclusions

Despite limitations inherent to retrospective study designs and cohort heterogeneity, these findings indicate that abatacept is an efficacious and safe addition to GvHD prophylaxis in pediatric HSCT.