Prospective evaluation of sequential treatment of sclerotic chronic graft versus host disease with rituximab and nilotinib

Lotte van der Wagen, Liane te Boome, Marleen Schiffler, Inger Nijhof, Marieke Schoordijk, Suzanne van Dorp, Marijke van Dijk, Reinier Raymakers, Eefke Petersen, Moniek de Witte, Niels de Jong, Mar Bellido, Brigitte Bar, Ellen Meijer, Jurgen Kuball*

*Corresponding author for this work

    Research output: Contribution to journalArticleAcademicpeer-review

    9 Citations (Scopus)

    Abstract

    Sclerotic chronic graft vs. host disease (cGVHD) still has a large impact on morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). We performed the first prospective study to test whether sequential therapy of the anti-CD20 antibody rituximab followed by 6 months treatment with tyrosine kinase inhibitor nilotinib is a favorable treatment strategy for patients with sclerotic cGVHD. Twenty-nine patients were included, 24 were available for analysis. We observed objective responses in 71% of patients (two patients CR, 15 patients PR). Moreover, two out of five patients suffering from severe ulcerations showed complete resolution of ulcers. Observed responses lasted until the end of study follow-up. The majority of responding patients could reduce daily corticosteroid dose with more than 50%. Furthermore, CD5+ B-cells are significantly lower (p = 0.007) in responding patients at baseline, proposing a new biomarker predictive for response. In conclusion, sequential treatment of rituximab followed by nilotinib associates with a very high response rate in this difficult to treat patient population. CD5+ B-cells could assist in guiding treatment choices and might be a first step toward more personalized cGVHD treatment. This trial was registered at the Dutch clinical trial registry as NTR1222.

    Original languageEnglish
    Pages (from-to)1255-1262
    Number of pages8
    JournalBone marrow transplantation
    Volume53
    Issue number10
    DOIs
    Publication statusPublished - Oct-2018

    Keywords

    • HEMATOPOIETIC-CELL TRANSPLANTATION
    • CONSENSUS DEVELOPMENT PROJECT
    • SCLERODERMATOUS CHRONIC GVHD
    • ANTI-THYMOCYTE GLOBULIN
    • WORKING GROUP-REPORT
    • CD5(+) B-CELLS
    • IMATINIB MESYLATE
    • HEMATOLOGICAL MALIGNANCIES
    • UNRELATED DONORS
    • SALVAGE THERAPY

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