The efficacy of repeated treatment with B-cell depletion therapy in XXXX : an evaluation.

@entity1 @entity1252 @entity1667
OBJECTIVE: Since 2000, we have given B-cell depletion therapy (BCDT) with rituximab to 76 @entity1 with active @entity1252 refractory to standard immunosuppression. Twenty-four of these @entity1 have now received repeated cycles of BCDT. The aims of the study were to: (i) assess the efficacy and safety of repeated cycles of BCDT in treating refractory @entity1252 ; and (ii) assess whether retreatment produced a more sustained clinical response. METHODS: BCDT was administered using CYC 750 mg, @entity1667 125-250 mg and rituximab 1 g given intravenously on two occasions, 2 weeks apart. @entity1 were reviewed at 1-2 monthly intervals and disease activity assessed using the BILAG activity index and serological markers. Clinical response was categorized as complete or partial remission, or no response, based on the change in BILAG scores. RESULTS: Eighteen @entity1 had sufficient data for detailed analysis. All were female; mean age 29.9 years; mean duration of follow-up 58.7 months. Two @entity1 died during follow-up and there were two infusion reactions. Disease activity was significantly reduced after both cycles of BCDT at 6 months. More @entity1 achieved disease remission after the second cycle (82 vs 61% first cycle), which was maintained in 65% at 12 months (vs 39% first cycle). The time to disease flare was significantly longer after the second cycle (P < 0.001) and 33% of our @entity1 have still not flared to date following retreatment (mean follow-up 24.5 months). CONCLUSION: Repeated cycles of BCDT with rituximab are effective in treating refractory @entity1252 and has a favourable safety profile. Retreatment may produce a more sustained clinical response.
