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), receivingRituximab for refractory cGVHD, assessed for clinical response and survival. Median duration of cGVHD before Rituximab was 23 months(range 2–116), the median number of failed treatment lines was 3 (range 1 to >=6) and the median follow-up after Rituximab was 11 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 (n=3), disease relapse (n=1), infection (n=3), sudden death (n=1). Theactuarial 2 year survival is currently 76%. We confirm that Rituximab is effective in over 50% of patients with refractory cGVHD and may have a beneficial impact on survival.