Clinical utility of rituximab in chronic graft-versus-host disease.

Abstract

OBJECTIVE:

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

DATA SOURCES:

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.

STUDY SELECTION AND DATA EXTRACTION:

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.

DATA SYNTHESIS:

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.

• Authors: Jill S Bates, Ashley Morris Engemann, Julia M Hammond
• Journal: The Annals of pharmacotherapy (Ann Pharmacother) Vol. 43 Issue 2 Pg. 316-21 (Feb 2009) ISSN: 1542-6270 [Electronic] United States
• PMID: 19193571 (Publication Type: Journal Article, Review)

Chemical References

• Antibodies, Monoclonal
• Antibodies, Monoclonal, Murine-Derived
• Immunosuppressive Agents
• Steroids
• Rituximab

Topics

• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Murine-Derived
• B-Lymphocytes (immunology)
• Chronic Disease (classification, drug therapy)
• Clinical Trials as Topic
• Drug Resistance
• Graft vs Host Disease (classification, drug therapy, immunology)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Rituximab
• Steroids (therapeutic use)
• Transplantation Conditioning