A pilot study of combining rituximab and low-dose (1.0Gy) total nodal irradiation in treatment of extensive chronic graft-versus-host disease

Chronic graft-versus-host disease (cGVHD) is a significant complication for many patients who survive an allogeneic bone marrow transplantation for haematological maligancy. A number of patients with extensive cGVHD have suboptimal control despite adequate steroid-based therapy with other immunosuppression such as cyclosporin. There is no standard salvage treatment to effectively control the disease and avoid long-term toxicity of steroids. This is the first prospective pilot study to explore the use of a single-dose of rituximab plus Low-dose total nodal irradiation (TNI) in the treatment of cGVHD involving the skin and other organ(s). There are a growing body of retrospective data regarding the effectiveness of rituximab and TNI respectively for the treatment of cGVHD. The hypothesis in this pilot study is that the combined treatment approach is safe and effective in treating extensive cGVHD.