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.

DESIGN AND 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: Seok Jin Kim, Jong Wook Lee, Chul Won Jung, Chang Ki Min, Bin Cho, Ho Jin Shin, Joo Seop Chung, Hawk Kim, Won Sik Lee, Young Don Joo, Deok-Hwan Yang, Hoon Kook, Hyoung Jin Kang, Hyo Seop Ahn, Sung-Soo Yoon, Sang Kyun Sohn, Yoo Hong Min, Woo-Sung Min, Hee-Sook Park, Jong Ho Won
• Journal: Haematologica (Haematologica) Vol. 95 Issue 11 Pg. 1935-42 (Nov 2010) ISSN: 1592-8721 [Electronic] Italy
• PMID: 20663943 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• B-Cell Activating Factor
• Immunologic Factors
• Steroids
• Rituximab

Topics

• Adolescent
• Adult
• Antibodies, Monoclonal, Murine-Derived (administration & dosage)
• B-Cell Activating Factor (blood)
• B-Lymphocytes (metabolism)
• Chemical and Drug Induced Liver Injury (blood, therapy)
• Child
• Chronic Disease
• Diabetes Mellitus (blood, therapy)
• Female
• Graft vs Host Disease (blood, drug therapy, metabolism)
• Hematologic Neoplasms (blood, therapy)
• Humans
• Immunologic Factors (administration & dosage)
• Male
• Middle Aged
• Prospective Studies
• Rituximab
• Stem Cell Transplantation
• Steroids (therapeutic use)
• Transplantation, Homologous
• Tuberculosis (blood, therapy)