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DRUG INFORMATION ROUNDS

Clinical Utility of Rituximab in Chronic Graft-Versus-Host Disease

Hematology/Oncology Specialty Resident, Department of Pharmacy, Duke University Medical Center, Durham, NC

Ashley Morris Engemann, PharmD BCOP

Clinical Associate, Division of Cellular Therapy, Department of Medicine, Duke University Medical Center

Julia M Hammond, PharmD BCOP

Oncology Clinical Coordinator, Department of Pharmacy, Duke University Medical Center

Reprints: Dr. Bates, Department of Pharmacy, DUMC Box 3089, Durham, NC 27710, fax 919/681-2471, jill.bates{at}duke.edu

OBJECTIVE: To evaluate the use of rituximab in the clinical management of steroid-refractory chronic graft-versus-host disease (GVHD).

DATA SOURCES: Literature was accessed through MEDLINE and International Pharmaceutical Abstracts (1990–September 2008), both indexed and nonindexed citations, using the terms rituximab, graft-versus-host disease, monoclonal antibodies, and CD20. In addition, reference citations from the publications identified were reviewed.

STUDY SELECTION AND DATA EXTRACTION: All articles discussing rituximab as a therapeutic option in the treatment of GVHD that were published in English and enrolled human study participants were evaluated.

DATA SYNTHESIS: Rituximab is a genetically engineered chimeric murine monoclonal antibody that binds to the CD20 differentiation antigen found on B-lymphocytes. GVHD is the leading cause of procedural-related morbidity and mortality following allogeneic hematopoietic stem cell transplantation (HSCT). Chronic GVHD (cGVHD) occurs in up to 70% of individuals undergoing HSCT, and approximately 40% of those patients are refractory to conventional T-lymphocyte–directed therapies. Limited treatments are available for individuals with steroid-refractory cGVHD. Rituximab therapy in individuals with extensive cGVHD has demonstrated clinical efficacy with manageable toxicities in retrospective and prospective studies.

CONCLUSIONS: Available data suggest that rituximab is a treatment option for patients with extensive steroid-refractory cGVHD. Rituximab may be particularly effective for individuals with steroid-refractory cGVHD manifesting as thrombocytopenia or with sclerodermatous, cutaneous, and rheumatologic involvement.

Key Words: CD20, graft-versus-host disease, monoclonal antibodies, rituximab

Published Online, February 3, 2009. www.theannals.com, DOI 10.1345/aph.1L386