Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease
Background Chronic graft-versus-host disease is a common late complication of allogeneic hematopoietic stem cell transplantation. Corticosteroids are the standard initial treatment. Second-line treatment has not been well defined. We evaluated the effectiveness and safety of low doses of alemtuzumab...
| Autores principales: | , , , , , , , , , |
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| Formato: | Artículo |
| Lenguaje: | inglés |
| Publicado: |
2012
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| Acceso en línea: | http://eprints.uanl.mx/15027/1/627.pdf |
| _version_ | 1824414229378105344 |
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| author | Gutiérrez Aguirre, César Homero Cantú Rodríguez, Olga Graciela Borjas Almaguer, Omar David González Llano, Óscar Jaime Pérez, José Carlos Solano Genesta, M. Gómez Guijosa, Miguel Ángel Mancías Guerra, Consuelo Tarín Arzaga, Luz del Carmen Gómez Almaguer, David |
| author_facet | Gutiérrez Aguirre, César Homero Cantú Rodríguez, Olga Graciela Borjas Almaguer, Omar David González Llano, Óscar Jaime Pérez, José Carlos Solano Genesta, M. Gómez Guijosa, Miguel Ángel Mancías Guerra, Consuelo Tarín Arzaga, Luz del Carmen Gómez Almaguer, David |
| author_sort | Gutiérrez Aguirre, César Homero |
| collection | Repositorio Institucional |
| description | Background Chronic graft-versus-host disease is a common late complication of allogeneic hematopoietic stem cell transplantation. Corticosteroids are the standard initial treatment. Second-line treatment has not been well defined. We evaluated the effectiveness and safety of low doses of alemtuzumab plus low doses of rituximab in the treatment of steroid-refractory chronic graftversus-host disease. Design and Methods Ten men and 5 women were prospectively included in the study. All patients received one cycle of subcutaneous alemtuzumab 10 mg/day/3 days and intravenous rituximab 100 mg on Days +4, +11, +18 and +25. The therapeutic response was measured on Days +30, +90 and +365 of the protocol. Results Median age was 41 years. The main site involved was the oral mucosa (86.7%) followed by the eyes (66.7%), liver (60%), skin (53%), lungs (13.3%) and intestinal tract (6.7%). The overall response was 100% at Day +30 evaluation: 10 patients (67%) had partial remission, 5 (33%) had complete remission. At Day +90 evaluation, 7 (50%) patients had partial remission, 4 (28%) had complete remission; 3 (21%) had relapsed chronic graft-versus-host disease and one patient did not reach the evaluation time point. So far, 5 patients have reached the Day +365 follow-up evaluation; 2 (40%) had partial remission, 2 had complete remission and one experienced chronic graft-versus-host disease progression. Adverse effects were mainly infections in 67% of patients; these were all quickly solved, except for one patient who died from pneumonia. Conclusions This combination therapy appears to be an efficacious and safe treatment for steroid-refractory chronic graft-versus-host disease. Longer follow up to determine the durability of response and survival is required (ClinicalTrials.gov: NCT01042509). |
| format | Article |
| id | eprints-15027 |
| institution | UANL |
| language | English |
| publishDate | 2012 |
| record_format | eprints |
| spelling | eprints-150272023-05-09T16:28:43Z http://eprints.uanl.mx/15027/ Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease Gutiérrez Aguirre, César Homero Cantú Rodríguez, Olga Graciela Borjas Almaguer, Omar David González Llano, Óscar Jaime Pérez, José Carlos Solano Genesta, M. Gómez Guijosa, Miguel Ángel Mancías Guerra, Consuelo Tarín Arzaga, Luz del Carmen Gómez Almaguer, David Background Chronic graft-versus-host disease is a common late complication of allogeneic hematopoietic stem cell transplantation. Corticosteroids are the standard initial treatment. Second-line treatment has not been well defined. We evaluated the effectiveness and safety of low doses of alemtuzumab plus low doses of rituximab in the treatment of steroid-refractory chronic graftversus-host disease. Design and Methods Ten men and 5 women were prospectively included in the study. All patients received one cycle of subcutaneous alemtuzumab 10 mg/day/3 days and intravenous rituximab 100 mg on Days +4, +11, +18 and +25. The therapeutic response was measured on Days +30, +90 and +365 of the protocol. Results Median age was 41 years. The main site involved was the oral mucosa (86.7%) followed by the eyes (66.7%), liver (60%), skin (53%), lungs (13.3%) and intestinal tract (6.7%). The overall response was 100% at Day +30 evaluation: 10 patients (67%) had partial remission, 5 (33%) had complete remission. At Day +90 evaluation, 7 (50%) patients had partial remission, 4 (28%) had complete remission; 3 (21%) had relapsed chronic graft-versus-host disease and one patient did not reach the evaluation time point. So far, 5 patients have reached the Day +365 follow-up evaluation; 2 (40%) had partial remission, 2 had complete remission and one experienced chronic graft-versus-host disease progression. Adverse effects were mainly infections in 67% of patients; these were all quickly solved, except for one patient who died from pneumonia. Conclusions This combination therapy appears to be an efficacious and safe treatment for steroid-refractory chronic graft-versus-host disease. Longer follow up to determine the durability of response and survival is required (ClinicalTrials.gov: NCT01042509). 2012 Article PeerReviewed text en cc_by_nc_nd http://eprints.uanl.mx/15027/1/627.pdf http://eprints.uanl.mx/15027/1.haspreviewThumbnailVersion/627.pdf Gutiérrez Aguirre, César Homero y Cantú Rodríguez, Olga Graciela y Borjas Almaguer, Omar David y González Llano, Óscar y Jaime Pérez, José Carlos y Solano Genesta, M. y Gómez Guijosa, Miguel Ángel y Mancías Guerra, Consuelo y Tarín Arzaga, Luz del Carmen y Gómez Almaguer, David (2012) Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease. Haematologica, 97 (5). pp. 717-722. ISSN 0390-6078 http://doi.org/10.3324/haematol.2011.054577 doi:10.3324/haematol.2011.054577 |
| spellingShingle | Gutiérrez Aguirre, César Homero Cantú Rodríguez, Olga Graciela Borjas Almaguer, Omar David González Llano, Óscar Jaime Pérez, José Carlos Solano Genesta, M. Gómez Guijosa, Miguel Ángel Mancías Guerra, Consuelo Tarín Arzaga, Luz del Carmen Gómez Almaguer, David Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| thumbnail | https://rediab.uanl.mx/themes/sandal5/images/online.png |
| title | Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| title_full | Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| title_fullStr | Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| title_full_unstemmed | Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| title_short | Effectiveness of subcutaneous low-dose alemtuzumab and rituximab combination therapy for steroid-resistant chronic graft-versus-host disease |
| title_sort | effectiveness of subcutaneous low dose alemtuzumab and rituximab combination therapy for steroid resistant chronic graft versus host disease |
| url | http://eprints.uanl.mx/15027/1/627.pdf |
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