ABSTRACT
A brief overview of Bayesian statistics is given, followed by illustrative applications of Bayesian methods in allogeneic hematopoietic cell transplantation (allo-HCT) and cellular therapy. Three clinical trial designs are described, including a study to evaluate safety and efficacy of cytotoxic T-lymphocytes for posttransplant viral infections, a trial to optimize chimeric antigen receptor T-cell dose for hematologic malignancies based on efficacy-toxicity trade-offs, and a randomized study of cord blood derived regulatory T-cells for COVID-19 induced acute respiratory distress syndrome. Three data analyses are described, including a sensitivity analysis of preparative regimen effects for allo-HCT that are confounded with institutional effects, regression-based estimation of the effects on survival of antigens in convalescent plasma therapy for COVID-19, and precision pharmacokinetic-guided dosing of intravenous busulfan in allo-HCT.
ABSTRACT
Little has been published in terms of dose-finding methodology in virology. Aside from a few papers focusing on HIV, the considerable progress in dose-finding methodology of the last 25 years has focused almost entirely on oncology. While adverse reactions to cytotoxic drugs may be life threatening, for anti-viral agents we anticipate something different: side effects that provoke the cessation of treatment. This would correspond to treatment failure. On the other hand, success would not be yes/no but would correspond to a range of responses, from small, no more than say 20% reduction in viral load to the complete elimination of the virus. Less than total success matters since this may allow the patient to achieve immune-mediated clearance. The motivation for this article is an upcoming dose-finding trial in chronic norovirus infection. We propose a novel methodology whose goal is twofold: first, to identify the dose that provides the most favorable distribution of treatment outcomes, and, second, to do this in a way that maximizes the treatment benefit for the patients included in the study.