Clinical utility of rituximab in chronic graft-versus-host disease.
OBJECTIVE
To evaluate the use of rituximab in the clinical management of steroid-refractory chronic graft-versus-host disease (GVHD).


METHODS
Literature was accessed through MEDLINE and International Pharmaceutical Abstracts (1990-September 2008), both indexed and nonindexed citations, using the terms rituximab, graft-versus-host disease, monoclonal antibodies, and CD20. In addition, reference citations from the publications identified were reviewed.


METHODS
All articles discussing rituximab as a therapeutic option in the treatment of GVHD that were published in English and enrolled human study participants were evaluated.


RESULTS
Rituximab is a genetically engineered chimeric murine monoclonal antibody that binds to the CD20 differentiation antigen found on B-lymphocytes. GVHD is the leading cause of procedural-related morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT). Chronic GVHD (cGVHD) occurs in up to 70% of individuals undergoing HSCT, and approximately 40% of those patients are refractory to conventional T-lymphocyte-directed therapies. Limited treatments are available for individuals with steroid-refractory cGVHD. Rituximab therapy in individuals with extensive cGVHD has demonstrated clinical efficacy with manageable toxicities in retrospective and prospective studies.


CONCLUSIONS
Available data suggest that rituximab is a treatment option for patients with extensive steroid-refractory cGVHD. Rituximab may be particularly effective for individuals with steroid-refractory cGVHD manifesting as thrombocytopenia or with sclerodermatous, cutaneous, and rheumatologic involvement.
Bates
Jill S
JS
Department of Pharmacy, Duke University Medical Center, Durham, NC 27710, USA. jill.bates@duke.edu
Engemann
Ashley Morris
AM
Hammond
Julia M
JM
D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D058846:Antibodies, Monoclonal, Murine-Derived; D001402:B-Lymphocytes / Q000276:immunology; D002908:Chronic Disease / Q000145:classification / Q000188:drug therapy; D002986:Clinical Trials as Topic; D004351:Drug Resistance; D006086:Graft vs Host Disease / Q000145:classification / Q000188:drug therapy* / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D000069283:Rituximab; D013256:Steroids / Q000627:therapeutic use; D019172:Transplantation Conditioning
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D013256:Steroids; D000069283:Rituximab