Treatment of refractory chronic GVHD with rituximab: a GITMO study

The anti-CD20 chimaeric monoclonal antibody Rituximab has recently been shown to induce significant clinical response in a proportion of patients with refractory chronic graft-versus-host disease (cGVHD). We now report 38 patients, median age 48 years (22–61), receiving Rituximab for refractory cGVHD, assessed for clinical response and survival. Median duration of cGVHD before Rituximab was23 months(range 2–116), the median number of failed treatment lineswas3 (range 1 to X6) and the median follow-up after Rituximab was11 months (1–88). Overall response rate was 65%: skin 17/20 (63%), mouth 10/21 (48%), eyes6/14 (43%), liver 3/12 (25%), lung 3/8 (37.5%), joints4/5, gut 3/4, thrombocytopaenia 2/3, vagina 0/2, pure red cell aplasia 0/1 and, myasthenia gravis 1/1. During the study period 8/38 died: causes of death were cGVHD progression (n¼3), disease relapse (n¼1), infection (n¼3), sudden death (n¼1). The actuarial 2 year survival is currently 76%. We confirm that Rituximab iseffe ctive in over 50% of patientswith refractory cGVHD and may have a beneficial impact on survival.