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Arai, Sally; Sahaf, Bita; Narasimhan, Balasubramanian; Chen, George L.; Jones, Carol D.; Lowsky, Robert; Shizuru, Judith A.; Johnston, Laura J.; Laport, Ginna G.; Weng, Wen-Kai; Benjamin, Jonathan E.; Schaenman, Joanna; Brown, Janice; Ramirez, Jessica; Zehnder, James L.; Negrin, Robert S.; Miklos, David B.
Blood, 06/2012, Volume: 119, Issue: 25Journal Article
B cells are involved in the pathogenesis of chronic GVHD (cGVHD). We hypothesized that prophylactic anti–B-cell therapy delivered 2 months after transplantation would decrease allogeneic donor B-cell immunity and possibly the incidence of cGVHD. Therefore, in the present study, patients with high-risk chronic lymphocytic leukemia (n = 22) and mantle-cell lymphoma (n = 13) received a total lymphoid irradiation of 80 cGy for 10 days and antithymocyte globulin 1.5 mg/kg/d for 5 days. Rituximab (375 mg/m2) was infused weekly on days 56, 63, 70, and 77 after transplantation. The incidence of acute GVHD was 6%. The cumulative incidence of cGVHD was 20%. Nonrelapse mortality was 3%. Rituximab treatment after allogeneic transplantation significantly reduced B-cell allogeneic immunity, with complete prevention of alloreactive H-Y Ab development in male patients with female donors (P = .01). Overall survival and freedom from progression at 4 years for chronic lymphocytic leukemia patients were 73% and 47%, respectively; for mantle-cell lymphoma patients, they were 69% and 53%, respectively. This study is registered at www.clinicaltrials.gov as NCT00186628.
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