title: Treatment of chronic graft-versus-host disease with anti-CD20 chimeric monoclonal antibody.
abstract: We reviewed the clinical outcome of 8 patients with steroid-refractory chronic graft-versus-host disease (GVHD) who received an anti-CD20 chimeric monoclonal antibody (rituximab). Rituximab was given by intravenous infusion at a weekly dose of 375 mg/m(2) for 4 weeks. All patients had received extensive treatment with various immunosuppressive agents; 6 patients had also received extracorporeal photopheresis. All patients had extensive chronic GVHD with diffuse or localized sclerodermoid GVHD and xerophthalmia. Other extracutaneous involvements included cold agglutinin disease with the Raynaud phenomenon, membranous glomerulonephritis, and restrictive or obstructive lung disease. Four patients responded to treatment with ongoing resolution or improvement ranging from 265 to 846 days after therapy, despite recovery of B cells in 3 patients. Rituximab seems to have significant activity in the treatment of refractory chronic GVHD and should be considered for further study in patients with early disease. This study suggests a participating role of B cells in the pathogenesis of chronic GVHD.
authors.affiliation: Blood and Marrow Stem Cell Transplantation Program, University of Michigan Health System, Ann Arbor, USA. vratanat@umich.edu
authors.forename: Voravit
authors.initials: V
authors.lastname: Ratanatharathorn
authors.forename: Lois
authors.initials: L
authors.lastname: Ayash
authors.forename: Christopher
authors.initials: C
authors.lastname: Reynolds
authors.forename: Samuel
authors.initials: S
authors.lastname: Silver
authors.forename: Pavan
authors.initials: P
authors.lastname: Reddy
authors.forename: Michael
authors.initials: M
authors.lastname: Becker
authors.forename: James L M
authors.initials: JL
authors.lastname: Ferrara
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Uberti
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20 / Q000276:immunology; D001402:B-Lymphocytes / Q000187:drug effects / Q000473:pathology; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy* / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D045743:Scleroderma, Diffuse / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D014985:Xerophthalmia / Q000188:drug therapy / Q000209:etiology
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D018951:Antigens, CD20; D000069283:Rituximab