title: Weekly rituximab followed by monthly rituximab treatment for steroid-refractory chronic graft-versus-host disease: results from a prospective, multicenter, phase II study.
abstract: BACKGROUND
  Since it was suggested that B cells play a role in the pathogenesis of chronic graft-versus-host disease, rituximab, an anti-CD20 monoclonal antibody targeting B cells, has been shown to be effective in steroid-refractory, chronic graft-versus-host disease. However, most of the data were from small numbers of patients or retrospective analyses. We, therefore, conducted a multicenter phase II study to confirm the efficacy of this treatment strategy that targets B cells.
  
  
  METHODS
  We diagnosed and evaluated chronic graft-versus-host disease according to the National Institute of Health criteria for clinical trials on this condition. The treatment consisted of weekly intravenous infusions of rituximab for 4 weeks followed by monthly rituximab for 4 months. We evaluated the patients' responses and monitored their disease activity until their final visit, which was on day 365. We also assessed the patients' subsequent quality of life and serum levels of B-cell-activating factor of the tumor necrosis factor family.
  
  
  RESULTS
  Among 37 patients enrolled (median age, 29 years; range 8-57 years), 32 patients responded to rituximab with 8 complete and 24 partial responses. Twenty-one patients maintained their response for 1 year, so their steroid treatment was discontinued or its dose reduced (21/37, or 56.8%), and their scores representing quality of life were improved although these changes were not statistically significant. The responses were better for clinical manifestations of the skin, oral cavity and musculoskeletal system (response rate, 71.4-100%) than for other organs. However, infectious complications and primary disease relapse accounted for the majority of treatment failure. The pre-treatment serum level of B cell-activating factor of the tumor necrosis factor family was not associated with better treatment outcome (P=0.147).
  
  
  CONCLUSIONS
  Rituximab could improve clinical responses and quality of life of patients with steroid-refractory chronic graft-versus-host disease, although such patients may need active prophylaxis against infection.
authors.affiliation: Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Lee
authors.forename: Chul Won
authors.initials: CW
authors.lastname: Jung
authors.forename: Chang Ki
authors.initials: CK
authors.lastname: Min
authors.forename: Bin
authors.initials: B
authors.lastname: Cho
authors.forename: Ho Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Joo Seop
authors.initials: JS
authors.lastname: Chung
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.forename: Won Sik
authors.initials: WS
authors.lastname: Lee
authors.forename: Young Don
authors.initials: YD
authors.lastname: Joo
authors.forename: Deok-Hwan
authors.initials: DH
authors.lastname: Yang
authors.forename: Hoon
authors.initials: H
authors.lastname: Kook
authors.forename: Hyoung Jin
authors.initials: HJ
authors.lastname: Kang
authors.forename: Hyo Seop
authors.initials: HS
authors.lastname: Ahn
authors.forename: Sung-Soo
authors.initials: SS
authors.lastname: Yoon
authors.forename: Sang Kyun
authors.initials: SK
authors.lastname: Sohn
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
authors.forename: Woo-Sung
authors.initials: WS
authors.lastname: Min
authors.forename: Hee-Sook
authors.initials: HS
authors.lastname: Park
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Won
mesh_terms: D000293:Adolescent; D000328:Adult; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage*; D053264:B-Cell Activating Factor / Q000097:blood; D001402:B-Lymphocytes / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000628:therapy; D002648:Child; D002908:Chronic Disease; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D005260:Female; D006086:Graft vs Host Disease / Q000097:blood / Q000188:drug therapy* / Q000378:metabolism; D019337:Hematologic Neoplasms / Q000097:blood / Q000628:therapy; D006801:Humans; D007155:Immunologic Factors / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000069283:Rituximab; D033581:Stem Cell Transplantation; D013256:Steroids / Q000627:therapeutic use; D014184:Transplantation, Homologous; D014376:Tuberculosis / Q000097:blood / Q000628:therapy
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D053264:B-Cell Activating Factor; D007155:Immunologic Factors; D013256:Steroids; D000069283:Rituximab