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AML relapse after rituximab treatment for GvHD: crucial role for B cells in GvL responses

Bone Marrow Transplantation volume 51, pages 1245–1248 (2016)Cite this article

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Allogeneic hematopoietic stem cell transplantation (HSCT) is curative when a potent GvL response is induced, but is often complicated by GvHD. GvL responses and GvHD are lymphocyte driven because lymphocyte depletion with anti-thymocyte globulin (ATG) or MabCampath (anti-CD52) averted GvHD at the expense of much higher relapse rates. Initial efforts to understand the mechanisms of GvL and GvHD focused on T cells,1, 2 and later donor NK cells were recognized as important anti-tumor effector cells.3 Observations that GvHD and GvL responses were associated with the appearance of host- and tumor-specific antibodies4, 5, 6, 7, 8 and that B-cell depletion with the CD20-binding monoclonal antibody rituximab was effective in some patients with steroid-refractory GvHD suggested that B cells are involved in GvHD pathobiology.9, 10, 11, 12, 13 By inference it can be hypothesized that B cells are also involved in GvL allogeneic-immune responses, however, this remains to be determined.

To the best of our knowledge only one case report has been published describing disease relapse after rituximab treatment for GvHD.14 This 22-year-old man with pre-B-ALL received four cycles of rituximab for therapy-refractory chronic GvHD of the skin. One month after the last rituximab infusion the pre-B-ALL relapsed. This is in line with observations in a murine allogeneic HSCT model, where survival of mice with ALL was associated with the development of potent antibody responses directed against ALL.15

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Acknowledgements

This study was financially supported by an in-house grant of the AMC (AMC PhD Fellowship; MAG), the Dutch Cancer Society (HSP and MDH) and the Netherlands Organization for Scientific Research (NWO VIDI; MDH).

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Author notes

  1. C Huisman

    Present address: Department of Hematology, Erasmus MC, Rotterdam, The Netherlands.,

Authors and Affiliations

  1. AIMM Therapeutics, Academic Medical Center, Amsterdam, The Netherlands

    M A Gillissen, G de Jong, S E Levie, E Yasuda, A Q Bakker, P M van Helden & H Spits

  2. Department of Hematology, Academic Medical Center, Amsterdam, The Netherlands

    M A Gillissen, G de Jong, L M Evers, C Huisman & M D Hazenberg

  3. Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands

    S T Pals

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  1. M A Gillissen
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Correspondence to M D Hazenberg.

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Gillissen, M., de Jong, G., Levie, S. et al. AML relapse after rituximab treatment for GvHD: crucial role for B cells in GvL responses. Bone Marrow Transplant 51, 1245–1248 (2016). https://doi.org/10.1038/bmt.2016.90

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