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  • Letter to the Editor
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Rituximab as salvage therapy for refractory chronic GVHD

Bone Marrow Transplantation volume 41, pages 909–911 (2008)Cite this article

Chronic GVHD (cGVHD) remains a matter of concern after allo-SCT. Moreover, the incidence of cGVHD is likely to increase as a result of the increasing use of allo-SCT (especially with reduced-intensity conditioning regimens), peripheral blood stem cells as stem cell source and frequent donor lymphocyte infusions, all of which are known to increase the risk of cGVHD. Standard primary treatment of cGVHD remains a combination of corticosteroids (CS) and calcineurin inhibitors. There is no standard therapy for those who fail to respond to CS, and CS-resistant GVHD is associated with high morbidity.1 In addition, elderly patients are more exposed to the side effects of long-term CS.2 Thus, therapeutic options are usually limited for those patients. Rituximab (RTX) has been reported recently to be effective in cGVHD.3, 4, 5, 6, 7, 8, 9 The aim of this letter was to analyze the outcome of 15 patients treated with RTX as salvage therapy for refractory cGVHD in a single center.

This retrospective report describes 15 consecutive patients experiencing severe or refractory cGVHD, and who received intravenous infusions of RTX (375 mg/m2 per infusion) at weekly intervals for 4 weeks. Responding patients were allowed to receive one or two courses of maintenance therapy according to the attending physician's decision. Response to RTX was assessed 1 month after the last infusion. CR was defined as resolution of all manifestations in involved organs, while PR was defined as an improvement in each involved organ without any new organ involvement, or progression in a previously involved organ. Resistance was defined as lack of a CR/PR 1 month after the last RTX infusion, requirement for alternative therapy or death from GVHD before the last RTX infusion. The benefit in cGVHD was also evaluated in term of CS taper. The CS dose received was assessed 1 month after the last administration of RTX, and compared with the previous CS dose received at the time of first infusion of RTX. Failure was defined as the absence of CR or PR.

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Acknowledgements

We thank the nursing staff for providing excellent care for our patients and the physicians of the Hematology and Medical Oncology Departments at the Institut Paoli-Calmettes for their important study contributions and dedicated patient care. We also thank the ‘Association pour la Recherche sur le Cancer (ARC)’ (Pole ARECA), the ‘Ligue Nationale contre le Cancer’, the ‘Fondation de France’, the ‘Fondation contre la Leucémie’, the ‘Agence de Biomédecine’, the ‘Association Cent pour Sang la Vie’ and the ‘Association Laurette Fuguain’ for their generous and continuous support for our clinical and basic research work. We were supported by several grants from the French Ministry of Health as part of the ‘Programme Hospitalier de Recherche Clinique (PHRC)’.

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Authors and Affiliations

  1. Department of Haematology, Unité de Transplantation et de Thérapie Cellulaire (UTTC), Institut Paoli-Calmettes, Marseille, France

    M Mohty, N Marchetti, J El-Cheikh, C Faucher, S Fürst & D Blaise

  2. Department of Haematology, Faculté de Médecine, Université de la Méditerranée, Marseille, France

    M Mohty & D Blaise

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  1. M Mohty
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Correspondence to M Mohty.

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Mohty, M., Marchetti, N., El-Cheikh, J. et al. Rituximab as salvage therapy for refractory chronic GVHD. Bone Marrow Transplant 41, 909–911 (2008). https://doi.org/10.1038/bmt.2008.12

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