Colunga-Pedraza Perla R, Barbosa-Castillo Luz María, Coronado-Alejandro Edgar Ulises, Vaquera-Alfaro Héctor Alejandro, López-Reyna Ingrid Gabriela, Colunga-Pedraza Julia E, Gómez-Almaguer David
Hematology service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Francisco I. Madero, Monterrey, Nuevo León 64460, Mexico.
Hematology service, Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León, Ave. Francisco I. Madero, Monterrey, Nuevo León 64460, Mexico.
Transpl Immunol. 2023 Dec;81:101959. doi: 10.1016/j.trim.2023.101959. Epub 2023 Nov 14.
Chronic graft-versus-host disease (cGvHD) is a major complication that puts patients undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT) at risk of death or infection. Currently, there is no gold standard for the first-line treatment of patients who do not respond to steroids, and there are several therapeutic options being evaluated in clinical trials for this disease to be used even in the first-line treatment for GvHD. There is evidence of the benefit of rituximab, an anti-CD20 antibody, at a standard dose of 375 mg/m weekly in the treatment of steroid-refractory chronic graft-versus disease (SR-cGvHD).
To demonstrate the safety and efficacy of low-dose rituximab in a middle-income center in northeastern Mexico STUDY DESIGN: We report the experience of 26 patients with chronic graft-versus-graft disease who received low-dose rituximab (100 mg weekly for 4 weeks). We utilized the advances in the National Institutes of Health (NIH) criteria for diagnosis, scoring, trial design, and assessment of treatment response.
We obtained a 5-year overall survival of 23.6%, including four patients with complete response. The 1-year event-free survival was 70% for patients with rituximab. During the treatment, there were 3 hospitalizations, and the causes were: immune thrombocytopenia, a parapneumonic effusion, and a cerebral vascular event. The median length of hospital stay was twelve days.
A low dose of rituximab is an available and cost-effective option for patients with steroid-refractory cGvHD.
慢性移植物抗宿主病（cGvHD）是同种异体造血干细胞移植（allo-HSCT）患者面临死亡或感染风险的主要并发症。目前，对于对类固醇无反应的患者，一线治疗尚无金标准，并且有几种治疗方案正在针对该疾病进行临床试验评估，甚至可用于移植物抗宿主病的一线治疗。有证据表明，标准剂量为375mg/m²每周一次的抗CD20抗体利妥昔单抗在治疗类固醇难治性慢性移植物抗宿主病（SR-cGvHD）方面具有益处。
在墨西哥东北部的一个中等收入中心证明低剂量利妥昔单抗的安全性和有效性。
我们报告了26例接受低剂量利妥昔单抗（每周100mg，共4周）治疗的慢性移植物抗宿主病患者的经验。我们采用了美国国立卫生研究院（NIH）在诊断、评分、试验设计和治疗反应评估标准方面的进展。
我们获得了23.6%的5年总生存率，其中包括4例完全缓解的患者。接受利妥昔单抗治疗的患者1年无事件生存率为70%。治疗期间，有3例住院，原因分别为：免疫性血小板减少症、类肺炎性胸腔积液和脑血管事件。中位住院时间为12天。
低剂量利妥昔单抗是类固醇难治性cGvHD患者可用且具有成本效益的选择。
