Safety and efficacy of low-dose rituximab in steroid-refractory cGvHD

Currently, there is no one standard of care for first-line treatment of patients with chronic graft-versus-host disease (cGvHD) who do not respond to steroids.¹ There is evidence to support the use of rituximab, a chimeric anti-CD20 antibody (when administrated weekly at a dose of 375 mg/ m²), as an adequate treatment option; however, it is not cost-effective.¹

Here, we summarize key findings by Colunga-Pedraza et al.¹ in Transplant Immunology on the use of low-dose rituximab in steroid-refractory cGvHD (SR-cGvHD).

Study design¹

• In total, 26 patients with SR-cGvHD, who had received low-dose rituximab (100 mg weekly for 4 weeks) were included for analysis
• cGvHD was classified as per the 2014 National Institutes of Health criteria
• SR-cGvHD was categorized as cGvHD progression while on prednisone ≥ 1 mg/kg/day for 1–2 weeks or stable cGvHD while on ≥0.5 mg/kg/day for 1–2 months
• Overall, 13 patients received rituximab for ≤31 days from the commencement of cGvHD therapy

Key findings¹

Table 1. Overall survival in patients with and without rituximab treatment*

• The overall response rate for patients treated with low-dose rituximab was 92%
• Overall, 1-year event-free survival was achieved in 70% of patients
• The occurrence of progression/relapse within 1-year was observed at a rate of 25%
• By the end of the study period, 27% of patients did not have a recurrence of GvHD
• In total, 58% of patients experienced adverse events, with Grade 1 and 2 infections being the most common (46%)