Zaja F, Bacigalupo A, Patriarca F, Stanzani M, Van Lint M T, Filì C, Scimè R, Milone G, Falda M, Vener C, Laszlo D, Alessandrino P E, Narni F, Sica S, Olivieri A, Sperotto A, Bosi A, Bonifazi F, Fanin R
Clinica Ematologica DIRM, Azienda Ospedaliera Universitaria, Udine, Italy.
Bone Marrow Transplant. 2007 Aug;40(3):273-7. doi: 10.1038/sj.bmt.1705725. Epub 2007 Jun 4.
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), receiving Rituximab 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 > or =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%), eyes 6/14 (43%), liver 3/12 (25%), lung 3/8 (37.5%), joints 4/5, 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). The actuarial 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.
抗CD20嵌合单克隆抗体利妥昔单抗最近已被证明可在一部分难治性慢性移植物抗宿主病（cGVHD）患者中诱导显著的临床反应。我们现在报告38例接受利妥昔单抗治疗难治性cGVHD的患者，年龄中位数为48岁（22 - 61岁），评估其临床反应和生存率。利妥昔单抗治疗前cGVHD的中位病程为23个月（范围2 - 116个月），治疗失败的中位数次数为3次（范围1至≥6次），利妥昔单抗治疗后的中位随访时间为11个月（1 - 88个月）。总体缓解率为65%：皮肤17/20（63%），口腔10/21（48%），眼睛6/14（43%），肝脏3/12（25%），肺3/8（37.5%），关节4/5，肠道3/4，血小板减少症2/3，阴道0/2，纯红细胞再生障碍性贫血0/1，重症肌无力1/1。在研究期间，38例中有8例死亡：死亡原因是cGVHD进展（n = 3）、疾病复发（n = 1）、感染（n = 3）、猝死（n = 1）。目前2年精算生存率为76%。我们证实利妥昔单抗对超过50%的难治性cGVHD患者有效，并且可能对生存率有有益影响。
