Rituximab Effective Against Chronic Graft-Versus-Host Disease
Rituximab is effective in treating transplant patients with chronic graft-versus-host disease (GVHD) that is refractory to corticosteroid therapy, according to a report in the March 21 online edition of Blood.
"We would like physicians to consider using this compound for patients with chronic GVHD, particularly those with musculoskeletal and cutaneous involvement," Dr. Corey Cutler from Dana-Farber Cancer Institute, Boston, Massachusetts told Reuters Health. "This is where we noted the drug to be most active."
Dr. Cutler and colleagues investigated the effectiveness of rituximab in 21 patients with clinically extensive chronic GVHD that had not responded to treatment with corticosteroids and at least one other form of systemic immunosuppression.
Circulating CD19 B cells became undetectable by eight weeks after commencing rituximab therapy and remained undetectable in all patients for at least one year, the researchers report. Median circulating levels of IgG and IgM also fell significantly by week 16 after rituximab therapy.
Fourteen of 20 patients showed objective responses to rituximab, the results indicate, including two subjects with a complete clinical response. About two thirds of the patients had a dose reduction of at least 50% in corticosteroid doses.
Median body surface involvement of cutaneous GVHD fell by more than one half at one year, the investigators observe, and there were significant improvements in rheumatologic visual analog scales for pain and fatigue.
Patients with significant ocular or oral mucosal manifestations of GVHD did not show significant clinical responses, the researchers note.
All four patients with demonstrable H-Y antibodies showed clinical responses to rituximab therapy, the report indicates, including one patient who had a complete response and was able to discontinue all immunosuppressive and another patient who was able to discontinue corticosteroids and continues to follow a tapering course of other immunosuppressive.
"The clinical effectiveness of rituximab in chronic GVHD implicates the B cell system in the complex process of chronic GVHD," Dr. Cutler pointed out. "Its usefulness certainly does not exclude the T cell system, but makes us believe that there is a complex interplay between multiple elements of the immune system in the pathophysiology of chronic GVHD."
Dr. Cutler said his group is working with the Bone Marrow Transplant Clinical Trials Network on a trial that will test rituximab as initial therapy for chronic GVHD. "In addition, we have begun a clinical trial of rituximab as prophylaxis against chronic GVHD at our center."
Blood 2006.
"We would like physicians to consider using this compound for patients with chronic GVHD, particularly those with musculoskeletal and cutaneous involvement," Dr. Corey Cutler from Dana-Farber Cancer Institute, Boston, Massachusetts told Reuters Health. "This is where we noted the drug to be most active."
Dr. Cutler and colleagues investigated the effectiveness of rituximab in 21 patients with clinically extensive chronic GVHD that had not responded to treatment with corticosteroids and at least one other form of systemic immunosuppression.
Circulating CD19 B cells became undetectable by eight weeks after commencing rituximab therapy and remained undetectable in all patients for at least one year, the researchers report. Median circulating levels of IgG and IgM also fell significantly by week 16 after rituximab therapy.
Fourteen of 20 patients showed objective responses to rituximab, the results indicate, including two subjects with a complete clinical response. About two thirds of the patients had a dose reduction of at least 50% in corticosteroid doses.
Median body surface involvement of cutaneous GVHD fell by more than one half at one year, the investigators observe, and there were significant improvements in rheumatologic visual analog scales for pain and fatigue.
Patients with significant ocular or oral mucosal manifestations of GVHD did not show significant clinical responses, the researchers note.
All four patients with demonstrable H-Y antibodies showed clinical responses to rituximab therapy, the report indicates, including one patient who had a complete response and was able to discontinue all immunosuppressive and another patient who was able to discontinue corticosteroids and continues to follow a tapering course of other immunosuppressive.
"The clinical effectiveness of rituximab in chronic GVHD implicates the B cell system in the complex process of chronic GVHD," Dr. Cutler pointed out. "Its usefulness certainly does not exclude the T cell system, but makes us believe that there is a complex interplay between multiple elements of the immune system in the pathophysiology of chronic GVHD."
Dr. Cutler said his group is working with the Bone Marrow Transplant Clinical Trials Network on a trial that will test rituximab as initial therapy for chronic GVHD. "In addition, we have begun a clinical trial of rituximab as prophylaxis against chronic GVHD at our center."
Blood 2006.
posted by TM at 7:47 AM
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