title: Anti-CD20 monoclonal antibody treatment in 6 patients with therapy-refractory chronic graft-versus-host disease.
abstract: Chronic graft-versus-host disease (cGVHD) is an important determinant of long-term morbidity and mortality in allogeneic stem cell transplantation patients. Because cGVHD has clinical, histologic, and laboratory findings of autoimmune diseases and anti-B-cell therapy has shown efficacy in autoimmune diseases, we hypothesized that monoclonal anti-CD20 antibody therapy might improve patients with cGVHD. We treated 5 men and 1 woman with therapy-refractory extensive cGVHD with anti-CD20 monoclonal antibody. Intravenous infusion was given at a weekly dose of 375 mg/m(2) for 4 weeks. In case of incomplete clinical response, additional courses of 4 weeks were given. Five patients responded to treatment with marked clinical, biochemical, and histologic improvement. One patient failed to respond. Anti-CD20 monoclonal antibody seems to be effective in cGVHD. A controlled trial is mandatory to confirm these results. The outcome of this study suggests a participating role of B cells in the pathogenesis of cGVHD.
authors.affiliation: Department of Pathology H 04-312, University Medical Centre, PO Box 85500, 3508 GA Utrecht, the Netherlands. m.r.canningavandijk@azu.nl
authors.forename: Marijke R
authors.initials: MR
authors.lastname: Canninga-van Dijk
authors.forename: Hanneke M
authors.initials: HM
authors.lastname: van der Straaten
authors.forename: Rob
authors.initials: R
authors.lastname: Fijnheer
authors.forename: Cornelus J
authors.initials: CJ
authors.lastname: Sanders
authors.forename: Jan G
authors.initials: JG
authors.lastname: van den Tweel
authors.forename: Leo F
authors.initials: LF
authors.lastname: Verdonck
mesh_terms: D000293:Adolescent; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000276:immunology* / Q000627:therapeutic use*; D018951:Antigens, CD20 / Q000276:immunology*; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology* / Q000473:pathology / Q000628:therapy*; D006801:Humans; D007167:Immunotherapy; D007938:Leukemia / Q000276:immunology / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D018951:Antigens, CD20