Autonomous artificial intelligence prescribing a drug to prevent severe acute graft-versus-host disease in HLA-haploidentical transplants

Junren Chen (), Yigeng Cao (), Yahui Feng, Saibing Qi, Donglin Yang, Yu Hu, Aiming Pang, Qiujin Shen, Jieya Luo, Xiaowen Gong, Rongli Zhang, Xiaolin Zhai, Xueqian Li, Wen Yan, Xianjing Zhang, Mengyun Chen, Mingming Niu, Jialin Wei, Chen Liang, Weihua Zhai, Ningning Zhao, Xueou Liu, Sichang Liu, Wangsong Zhai, Ruixin Li, Xianfeng Shao, Dong Zhang, Mingyang Wang, Pan Pan, Mingyue Xu, Wei Zhang, Yunqiang Xu, Xiaofan Zhu, Ye Guo, Hong Wang, Zhen Song, Robert Peter Gale, Mingzhe Han, Sizhou Feng and Erlie Jiang ()
Additional contact information
Junren Chen: Chinese Academy of Medical Sciences & Peking Union Medical College
Yigeng Cao: Chinese Academy of Medical Sciences & Peking Union Medical College
Yahui Feng: Chinese Academy of Medical Sciences & Peking Union Medical College
Saibing Qi: Chinese Academy of Medical Sciences & Peking Union Medical College
Donglin Yang: Chinese Academy of Medical Sciences & Peking Union Medical College
Yu Hu: Chinese Academy of Medical Sciences & Peking Union Medical College
Aiming Pang: Chinese Academy of Medical Sciences & Peking Union Medical College
Qiujin Shen: Chinese Academy of Medical Sciences & Peking Union Medical College
Jieya Luo: Chinese Academy of Medical Sciences & Peking Union Medical College
Xiaowen Gong: Chinese Academy of Medical Sciences & Peking Union Medical College
Rongli Zhang: Chinese Academy of Medical Sciences & Peking Union Medical College
Xiaolin Zhai: Chinese Academy of Medical Sciences & Peking Union Medical College
Xueqian Li: Chinese Academy of Medical Sciences & Peking Union Medical College
Wen Yan: Chinese Academy of Medical Sciences & Peking Union Medical College
Xianjing Zhang: Chinese Academy of Medical Sciences & Peking Union Medical College
Mengyun Chen: Chinese Academy of Medical Sciences & Peking Union Medical College
Mingming Niu: Chinese Academy of Medical Sciences & Peking Union Medical College
Jialin Wei: Chinese Academy of Medical Sciences & Peking Union Medical College
Chen Liang: Chinese Academy of Medical Sciences & Peking Union Medical College
Weihua Zhai: Chinese Academy of Medical Sciences & Peking Union Medical College
Ningning Zhao: Chinese Academy of Medical Sciences & Peking Union Medical College
Xueou Liu: Chinese Academy of Medical Sciences & Peking Union Medical College
Sichang Liu: Chinese Academy of Medical Sciences & Peking Union Medical College
Wangsong Zhai: Chinese Academy of Medical Sciences & Peking Union Medical College
Ruixin Li: Chinese Academy of Medical Sciences & Peking Union Medical College
Xianfeng Shao: Chinese Academy of Medical Sciences & Peking Union Medical College
Dong Zhang: Chinese Academy of Medical Sciences & Peking Union Medical College
Mingyang Wang: Chinese Academy of Medical Sciences & Peking Union Medical College
Pan Pan: Chinese Academy of Medical Sciences & Peking Union Medical College
Mingyue Xu: Chinese Academy of Medical Sciences & Peking Union Medical College
Wei Zhang: Chinese Academy of Medical Sciences & Peking Union Medical College
Yunqiang Xu: Chinese Academy of Medical Sciences & Peking Union Medical College
Xiaofan Zhu: Chinese Academy of Medical Sciences & Peking Union Medical College
Ye Guo: Chinese Academy of Medical Sciences & Peking Union Medical College
Hong Wang: Chinese Academy of Medical Sciences & Peking Union Medical College
Zhen Song: Chinese Academy of Medical Sciences & Peking Union Medical College
Robert Peter Gale: Technology and Medicine
Mingzhe Han: Chinese Academy of Medical Sciences & Peking Union Medical College
Sizhou Feng: Chinese Academy of Medical Sciences & Peking Union Medical College
Erlie Jiang: Chinese Academy of Medical Sciences & Peking Union Medical College

Nature Communications, 2025, vol. 16, issue 1, 1-17

Abstract: Abstract Autonomous artificial intelligence (AI) models for deciding treatment strategies are available but rarely applied prospectively in clinical settings. Here we present a prospective study of deploying daGOAT, an algorithm we have developed, as a conditional autonomous AI agent to prescribe a drug to prevent severe (grade 3−4) acute graft-versus-host disease (acute GvHD) following human leukocyte antigen (HLA)-mismatched haematopoietic cell transplantation (ClinicalTrials.gov, NCT05600855). During the enrollment period physicians invite 85% of eligible patients to participate and 88% of the invited patients agree. Among the 110 enrolled participants who receive HLA-haploidentical transplants, daGOAT predicts intermediate to high risk of severe acute GvHD in 57 participants between days +17 and +23 posttransplant and prescribes ruxolitinib in addition to the existing regimen to intensify immune suppression. The initial compliance with AI prescription is 98% (56/57), with dose and/or schedule deviating from the AI prescription within one month in a total of eight participants. In conclusion, we show that many physicians and patients are receptive to using conditional autonomous AI to prescribe a drug and that the decision for pharmaceutical intervention could be facilitated by autonomous AI.

Date: 2025
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DOI: 10.1038/s41467-025-62926-0

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