title: Prophylactic rituximab after allogeneic transplantation decreases B-cell alloimmunity with low chronic GVHD incidence.
abstract: B cells are involved in the pathogenesis of chronic GVHD (cGVHD). We hypothesized that prophylactic anti-B-cell therapy delivered 2 months after transplantation would decrease allogeneic donor B-cell immunity and possibly the incidence of cGVHD. Therefore, in the present study, patients with high-risk chronic lymphocytic leukemia (n = 22) and mantle-cell lymphoma (n = 13) received a total lymphoid irradiation of 80 cGy for 10 days and antithymocyte globulin 1.5 mg/kg/d for 5 days. Rituximab (375 mg/m(2)) was infused weekly on days 56, 63, 70, and 77 after transplantation. The incidence of acute GVHD was 6%. The cumulative incidence of cGVHD was 20%. Nonrelapse mortality was 3%. Rituximab treatment after allogeneic transplantation significantly reduced B-cell allogeneic immunity, with complete prevention of alloreactive H-Y Ab development in male patients with female donors (P = .01). Overall survival and freedom from progression at 4 years for chronic lymphocytic leukemia patients were 73% and 47%, respectively; for mantle-cell lymphoma patients, they were 69% and 53%, respectively.
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, CA 94305, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Arai
authors.forename: Bita
authors.initials: B
authors.lastname: Sahaf
authors.forename: Balasubramanian
authors.initials: B
authors.lastname: Narasimhan
authors.forename: George L
authors.initials: GL
authors.lastname: Chen
authors.forename: Carol D
authors.initials: CD
authors.lastname: Jones
authors.forename: Robert
authors.initials: R
authors.lastname: Lowsky
authors.forename: Judith A
authors.initials: JA
authors.lastname: Shizuru
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Johnston
authors.forename: Ginna G
authors.initials: GG
authors.lastname: Laport
authors.forename: Wen-Kai
authors.initials: WK
authors.lastname: Weng
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Benjamin
authors.forename: Joanna
authors.initials: J
authors.lastname: Schaenman
authors.forename: Janice
authors.initials: J
authors.lastname: Brown
authors.forename: Jessica
authors.initials: J
authors.lastname: Ramirez
authors.forename: James L
authors.initials: JL
authors.lastname: Zehnder
authors.forename: Robert S
authors.initials: RS
authors.lastname: Negrin
authors.forename: David B
authors.initials: DB
authors.lastname: Miklos
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage* / Q000494:pharmacology; D015551:Autoimmunity / Q000187:drug effects; D001402:B-Lymphocytes / Q000187:drug effects / Q000276:immunology*; D018890:Chemoprevention / Q000379:methods; D002908:Chronic Disease; D004334:Drug Administration Schedule; D005240:Feasibility Studies; D005260:Female; D006086:Graft vs Host Disease / Q000453:epidemiology / Q000276:immunology / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology; D015994:Incidence; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D000069283:Rituximab; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007166:Immunosuppressive Agents; D000069283:Rituximab