Combination treatment of bullous pemphigoid with anti-CD20 and anti-CD25 antibodies in a patient with chronic graft-versus-host disease.
In this case report we describe a novel treatment with two chimeric monoclonal antibodies (MoAb) targeting the autoimmune B cell clone responsible for bullous pemphigoid (BP) as a manifestation of steroid refractory chronic graft-versus-host disease (GVHD) that developed after unrelated cord blood transplantation. Monitoring the BP-specific circulating antibodies and CD25-expressing activated T lymphocyte subset led us to combine anti-CD20 (Rituximab) mediated B cell ablation with anti-CD25 (Daclizumab) therapy to block CD4(+) T cell help. Complete clinical and serologic response was achieved within 4 weeks of initiation of therapy allowing global immunosuppression to be dramatically reduced.
Szabolcs
P
P
Department of Pediatrics, Pediatric Stem Cell Transplant Program, Duke University Medical Center, Durham, NC 27710, USA.
Reese
M
M
Yancey
K B
KB
Hall
R P
RP
Kurtzberg
J
J
D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000627:therapeutic use; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology; D002648:Child; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D004359:Drug Therapy, Combination; D006086:Graft vs Host Disease / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010391:Pemphigoid, Bullous / Q000188:drug therapy*; D015375:Receptors, Interleukin-2 / Q000276:immunology; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D018951:Antigens, CD20; D015375:Receptors, Interleukin-2