Rituximab for the treatment of corticosteroid-refractory chronic graft-versus-host disease

Center for Cellular and Molecular Medicine, Kyushu University Graduate School of Medical Science, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan.
International journal of hematology (Impact Factor: 1.92). 07/2009; 90(2):253-60. DOI: 10.1007/s12185-009-0370-x
Source: PubMed

ABSTRACT We prospectively evaluated the safety and efficacy of the anti-CD20 chimeric monoclonal antibody rituximab for the treatment of corticosteroid-refractory chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation. Seven patients were treated with 375 mg/m(2) rituximab weekly for 4 consecutive weeks. Rituximab was well tolerated with no severe toxicity observed during treatment. At 1 year, 3 patients showed a partial response to rituximab therapy, 3 had stable disease, and 1 had progressive disease. Rituximab allowed a reduction in the dose of steroids in 4 patients. Responsive manifestations included mild to moderate skin and oral lesions, and immune hemolytic anemia, and thrombocytopenia. Severe manifestations involving the skin, fascia, and eye did not respond to treatment. These observations suggest that rituximab therapy may be effective for select patients with corticosteroid-refractory chronic GVHD that is not advanced.

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    07/2014; 5(3):250-9. DOI:10.4103/2229-5178.137766
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    • "The pathogenic role of B lymphocytes was highlighted in renal, cardiac, liver or pancreas transplantation, justifying B-cell depletion with RTX.46–48 Allogeneic hematopoietic stem cell transplantation may induce acute or chronic destruction of the host by the donor’s immune system. Whilst pathogenic mechanisms involved in these phenomena are not clearly understood, RTX therapy may be effective for some patients (Table 1).49 "
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    ABSTRACT: Allogeneic hematopoietic stem cell transplantation is an established treatment modality for malignant and nonmalignant hematologic diseases. Acute and chronic graft-versus-host diseases (GVHDs) are a major cause of morbidity and mortality after allogeneic stem cell transplantation. T cells have been identified as key players in the graft-versus-host reaction and, therefore, most established drugs used against GVHD target T cells. Despite our knowledge on the pathogenesis of the GVH reaction, success of established therapies for prevention and treatment of GHVD is unsatisfactory. Recently, animal and human studies demonstrated that B cells are involved in the immunopathophysiology of acute and chronic GVHD. Early phase clinical trials of B-cell depletion with rituximab have shown beneficial effects on both acute and chronic GVHD. This review summarizes the current experimental and clinical evidence for the involvement of B cells in the pathogenesis of acute and chronic GVHD and discusses the clinical implications for the management of patients undergoing allogeneic stem cell transplantation.
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