Anti-CD20 monoclonal antibody treatment in 6 patients with therapy-refractory chronic graft-versus-host disease

Dijk, Marijke R. Canninga‐van; Straaten, Hanneke M.; Fijnheer, Rob; Sanders, C. J. G.; Tweel, Jan G. van den; Verdonck, Leo F.

doi:10.1182/blood-2004-05-1855

Cited by 125 publications

(91 citation statements)

References 23 publications

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“…4,[15][16][17] Ratanatharathorn et al 15 documented a sustained response in four of eight patients with steroid-refractory cGVHD with diffuse or localized sclerodermoid manifestations. Similarly, Canninga-vanDijk et al 16 and Okamoto et al…”

Section: Discussionmentioning

confidence: 99%

Treatment of refractory chronic GVHD with rituximab: a GITMO study

Zaja¹,

Bacigalupo

Patriarca³

et al. 2007

Bone Marrow Transplant

157

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Section: Discussionmentioning

confidence: 99%

Treatment of refractory chronic GVHD with rituximab: a GITMO study

Zaja¹,

Bacigalupo

Patriarca³

et al. 2007

Bone Marrow Transplant

157

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“…Two case series suggest that transient B-cell depletion can improve clinical manifestations of chronic GVHD with durable responses. 97,98 …”

Section: Eliminate B Cellsmentioning

confidence: 99%

New approaches for preventing and treating chronic graft-versus-host disease

Lee

2005

Blood

127

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Despite improvements in the practice of allogeneic hematopoietic stem cell transplantation (HCT) over the last 25 years, chronic graft-versus-host disease (GVHD) remains a substantial problem with little change in the incidence, morbidity, and mortality of this complication. In fact, with increased use of peripheral blood, transplantation of older patients, and less immediate transplantation-related mortality, the prevalence of chronic GVHD may increase. One of the difficulties in combating chronic GVHD is a lack of understanding about the pathophysiology of the syndrome. IntroductionChronic graft-versus-host disease (GVHD) is the most serious and common long-term complication of allogeneic hematopoietic stem cell transplantation (HCT), occurring in 20% to 70% of people surviving more than 100 days. 1,2 Approximately half of affected people have 3 or more involved organs, and treatment typically requires immunosuppressive medications for a median of 1 to 3 years. Because of higher treatment-related (nonrelapse) mortality, chronic GVHD remains the major cause of late death despite its association with a lower relapse rate. 3,4 In addition, secondary malignancies are more common in people with chronic GVHD, particularly of commonly involved tissues such as mouth and skin, suggesting that chronic inflammation, prolonged exposure to immunosuppressive medications, or immune dysregulation facilitates the development of new cancers. 5 Finally, the functional consequences of chronic GVHD organ involvement are major determinants of the health and quality of life of survivors. 6,7 Despite the well-recognized adverse effects of chronic GVHD on the long-term success of allogeneic transplantation, its pathophysiology is poorly understood, and management strategies beyond systemic corticosteroids have not been established.While there are some lessons that can be translated from basic and clinical studies of acute GVHD, several lines of evidence suggest that chronic GVHD is not simply a continuation of acute GVHD, and that separate approaches will be required for its prevention and management. First, except for T-cell depletion and use of umbilical cord blood, the major innovations that have improved acute GVHD rates do not seem to have affected chronic GVHD incidence. Second, while there is significant overlap between the organs involved in acute and chronic GVHD, the distribution of affected organs in chronic GVHD is much broader. Fully evolved chronic GVHD is largely an inflammatory and fibrotic process, while acute GVHD is more likely to reflect apoptosis and necrosis. Although traditionally the boundary between acute and chronic GVHD has been set at 100 days after transplantation, more recent definitions hinge on different clinical manifestations rather than time of onset. Third, while acute GVHD is highly associated with subsequent chronic GVHD, approximately 25% to 35% of chronic GVHD is de novo without any preceding acute manifestations, while 20% to 30% of people who had acute GVHD do not go on to develop chronic GVH...

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“…8,9 Recently, anti-CD20 has been reported useful in the treatment of refractory chronic GVHD. 10 Taken together, these reports suggest that anti-CD20 should be considered early in the treatment of steroid-refractory GVHD and other more unusual immune-mediated complications after HSCT. …”

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confidence: 99%