Treatment of chronic steroid-refractory graft-versus-host disease with low-dose rituximab

Rituximab, an anti-CD20 chimeric monoclonal antibody, is widely used in hematologic malignancies and has been introduced as a therapeutic option in autoimmune disorders. In recent studies, rituximab has shown promising activity in steroid-refractory chronic graft-versus-host disease (cGvHD) at a weekly dose of 375 mg/m(2). We now report on 13 Subjects after peripheral blood stem-cell transplantation receiving low-close rituximab (50 mg/m(2)) for steroid-refractory cGvHD and autoimmune disorders (membranous glomerulonephritis and immune thrombocytopenic purpura). The overall response rate was 69%, including two patients with complete responses. In accordance, we observed clearance of periperal blood B cells even after the first dose of rituximab in four patients. We Conclude that low-dose rituximab seems to be active and safe in intensively pretreated patients with steroid-refractory cGvHD.