We're building a better ClinicalTrials.gov. Check it out and tell us what you think!
ClinicalTrials.gov Menu

Imatinib and Rituximab in Treating Cutaneous Sclerosis in Patients With Chronic Graft-Versus-Host Disease

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
ClinicalTrials.gov Identifier: NCT01309997
Recruitment Status : Completed
First Posted : March 7, 2011
Results First Posted : June 15, 2016
Last Update Posted : June 15, 2016
National Cancer Institute (NCI)
Information provided by (Responsible Party):
Lee, Stephanie, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium

Brief Summary:
This randomized phase II trial is evaluating how well imatinib mesylate works compared to rituximab in treating cutaneous sclerosis in patients with chronic graft- versus-host disease (GVHD). Both imatinib and rituximab have been reported to decrease skin thickening and improve skin and joint flexibility in people with cutaneous sclerosis due to chronic GVHD.

Condition or disease Intervention/treatment Phase
Graft Versus Host Disease Systemic Scleroderma Drug: imatinib mesylate Biological: rituximab Phase 2

Detailed Description:


I. To determine the best clinical response rate of cutaneous sclerosis (skin and/or fascial thickening) after 6 months of initial therapy with either imatinib (imatinib mesylate) or rituximab.


I. To determine the best response at either the 3 or 6 month assessment.

II. To determine the response rate at the 3 month assessment.

III. To determine the proportion of subjects who are able to taper corticosteroid after 6 months of imatinib or rituximab therapy.

IV. To determine the incidence of treatment failure to initial treatment with either imatinib or rituximab.

V. To evaluate if the Scleroderma Health Assessment Questionnaire (SHAQ) findings correlate with severity of cutaneous sclerosis clinical findings and response to study treatment.

VI. To correlate the detection of antibody against platelet derived growth factor receptor alpha (PDGFR A) with clinical response.

VII. To correlate change in B cell relevant parameters from baseline to 6 months or early crossover (antibody levels, skin collagen expression, B cell subsets) with therapeutic agent and best clinical response while on initial treatment.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients receive imatinib mesylate by mouth (PO) once daily (QD) for 6 months in the absence of progression of sclerosis or unacceptable toxicity. Subjects with a significant clinical response will continue to receive study drug for an additional 6 months.

ARM II: Patients receive rituximab intravenously (IV) on days 1, 8, 15, and 22 (first cycle). A second cycle of treatment with rituximab is repeated at 3 months for a total of 8 doses of rituximab in the absence of progression of sclerosis or unacceptable toxicity.

Patients with progression, treatment intolerance at any time up to 6 months, or no clinical response at 6 months will crossover to the other treatment arm.

Layout table for study information
Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 72 participants
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Randomized Phase II Study of Imatinib and Rituximab for Cutaneous Sclerosis After Allogeneic Hematopoietic Cell Transplantation
Study Start Date : March 2011
Actual Primary Completion Date : December 2014
Actual Study Completion Date : December 2015

Arm Intervention/treatment
Experimental: Arm I (enzyme inhibitor)
Patients receive imatinib mesylate PO QD for 6 months in the absence of progression of sclerosis or unacceptable toxicity.
Drug: imatinib mesylate
Given PO
Other Names:
  • CGP 57148
  • Gleevec
  • Glivec

Experimental: Arm II (monoclonal antibody)
Patients receive rituximab IV on days 1, 8, 15, and 22. A second treatment cycle is repeated at 3 months for a total of 8 doses of rituximab in the absence of progression of sclerosis or unacceptable toxicity.
Biological: rituximab
Given IV
Other Names:
  • IDEC-C2B8
  • IDEC-C2B8 monoclonal antibody
  • Mabthera
  • Rituxan

Primary Outcome Measures :
  1. Significant Clinical Response [ Time Frame: 6 months ]
    Assessed by decline in an affected area's skin score as measured with the Vienna Skin Scale (from 4 [worst] to 2, 3 to 1, or 2 to 0 [best]) without a concurrent increase of two or more points in another area OR by an increase in the range of motion of the shoulders, elbows or wrists by two points (in a 1-7 scale where 1 is worst and 7 is best) or of the ankles by one point (in a 1 to 4 scale where 1 is worst and 4 is best) without a concurrent worsening in another area.

Secondary Outcome Measures :
  1. Patients Who Were Able to Taper Corticosteroids [ Time Frame: 6 months ]
    Patients who achieved a greater than or equal to 50% reduction in the daily corticosteroid dose at 6mo compared to baseline

  2. Cumulative Incidence of Treatment Failure [ Time Frame: 6 months ]
    Defined as discontinuation of randomized treatment due to chronic GVHD progression or treatment intolerance or no significant clinical response in sclerosis.

  3. Number of Patients Achieving Improvement in Cutaneous Sclerosis [ Time Frame: 6 months ]
    Assessed by decrease of >= 0.2 units (where 0 is best and 3.0 is worst ) in the Scleroderma Health Assessment Questionnaire (SHAQ).

  4. Baseline Histopathologic Score in the Two Treatment Arms [ Time Frame: Enrollment ]

    Instrument: Nash dermal fibrosis grade. Measures extent of sclerosis in skin biopsies by histologic examination. Scale ranges from grade 0-5. Nash grade 5 is most severe fibrosis (0 is better outcome, 5 is worse outcome). No subscales are used in Nash grade. Please see table 1 in the reference for grading of dermal fibrosis.

    Nash RA, McSweeney PA, Crofford LJ, Abidi M, Chen CS, Godwin JD, et al. High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation for severe systemic sclerosis: long-term follow-up of the US multicenter pilot study. Blood 2007;110:1388-96.

  5. Patients With Any Percentage Decline in Any Grade of Sclerosis Without Increase in Percentage of Higher Grades of Sclerosis in Other Areas on the Vienna Skin Scale [ Time Frame: 6 months ]
    Maximum of 10 body areas. Each area can be graded 0 (best) to 4 (worst). Each of those grades requires a percentage of involvement. Improvement is measured by reduction of involvement in any grade and any body area.

  6. Percentage of CD27+ B Cells in Responders (SCR) and Non-responders [ Time Frame: 6 months ]
    %CD27+ B cells

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

Layout table for eligibility information
Ages Eligible for Study:   2 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Diagnosis within the past 18 months of cutaneous sclerosis after hematopoietic cell transplant (HCT) with sclerotic skin, morphea, myofascial involvement or joint contractures; must have a score of 2 or greater on the Vienna skin scale in any area, or a range-of-motion (ROM) score of 5 or less at the shoulder, elbow or wrist, or 3 or less at the ankle
  • No medication added for the treatment of graft versus host disease (GVHD) within the past 4 weeks
  • Receiving corticosteroids at a dose greater than required for treatment of adrenal insufficiency, unless the physician documents why steroids are contraindicated
  • Age 2-99 years
  • Karnofsky performance status >= 60% at enrollment
  • All females of childbearing potential must have a negative serum or urine pregnancy test =< 7 days prior to starting study therapy
  • All females of childbearing potential must agree to use a form of Food and Drug Administration (FDA) approved contraception from enrollment to one month after study treatment ends
  • Subject has the ability to understand and willingness to sign a written informed consent document

Exclusion Criteria:

  • Total bilirubin > 1.5x upper limit of normal (ULN)
  • Aspartate aminotransferase (AST) or alanine aminotransferase (ALT) > 2.5 x ULN
  • Renal insufficiency (serum creatinine > 2.0 mg/dl)
  • Platelets < 30,000/ul or absolute neutrophil count < 1500/ul
  • Known hypersensitivity to rituximab or other anti-B cell antibodies
  • Known imatinib intolerance or allergy
  • Evidence of any active viral, bacterial, or fungal infection that is progressive despite appropriate treatment
  • Hepatitis B surface antigen positive
  • Hepatitis B core antibody positive, unless hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is undetectable
  • Hepatitis C antibody positive, unless hepatitis C virus (HCV) ribonucleic acid (RNA) is undetectable
  • Pregnant, lactating, or planning a pregnancy while in the study
  • Distal leg skin score 3 or higher as the only manifestation of sclerosis
  • Prior treatment of chronic GVHD with imatinib, rituximab, or any other monoclonal B-cell antibody (e.g. ofatumumab)
  • Receipt of imatinib within the previous 6 months for any indication
  • Receipt of any monoclonal B-cell antibody (e.g. rituximab, ofatumumab) within the previous 12 months for any indication
  • Treatment with anti-B-cell cellular therapy (e.g. chimeric antigen-receptor-engineered cells) at any time after transplant
  • Current treatment with extracorporeal photopheresis (ECP) at the time of enrollment
  • History of psychiatric disorder that would interfere with normal participation in this study
  • Inability or unwillingness of subject and/or parent guardian to provide informed consent or comply with study protocol
  • Use of non-FDA approved drugs within 4 weeks of participation
  • Patient with any condition that, in the opinion of the investigator, would interfere with the subject's ability to comply with the study requirements
  • Patients with uncontrolled substance abuse

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01309997

Layout table for location information
United States, Arizona
Mayo Clinic in Arizona
Scottsdale, Arizona, United States, 85259
United States, California
Stanford University Hospitals and Clinics
Stanford, California, United States, 94305
United States, Florida
H. Lee Moffitt Cancer Center and Research Institute
Tampa, Florida, United States, 33612
United States, Missouri
Washington University School of Medicine
Saint Louis, Missouri, United States, 63110
United States, New York
Roswell Park Cancer Institute
Buffalo, New York, United States, 14263
Weill Cornell Medical College
New York, New York, United States, 10065
United States, North Carolina
University of North Carolina
Chapel Hill, North Carolina, United States, 27599
United States, Tennessee
Vanderbilt-Ingram Cancer Center
Nashville, Tennessee, United States, 37232
United States, Washington
Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Seattle, Washington, United States, 98109
United States, Wisconsin
Froedtert and the Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Sponsors and Collaborators
Lee, Stephanie
National Cancer Institute (NCI)
Layout table for investigator information
Principal Investigator: Stephanie Lee Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
Publications of Results:
Layout table for additonal information
Responsible Party: Lee, Stephanie, Principal Investigator, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium
ClinicalTrials.gov Identifier: NCT01309997    
Other Study ID Numbers: 2343.00
NCI-2011-00098 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
RDCRN 6502 ( Other Identifier: Rare Diseases Clinical Research Network II )
2343.00 ( Other Identifier: Fred Hutchinson Cancer Research Center )
U54CA163438 ( U.S. NIH Grant/Contract )
P30CA015704 ( U.S. NIH Grant/Contract )
First Posted: March 7, 2011    Key Record Dates
Results First Posted: June 15, 2016
Last Update Posted: June 15, 2016
Last Verified: May 2016
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description: De-identified patient data and samples may be available with the appropriate approvals. Contact the PI for information.
Keywords provided by Lee, Stephanie, Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium:
Chronic Graft-vs-Host Disease
Additional relevant MeSH terms:
Layout table for MeSH terms
Scleroderma, Systemic
Scleroderma, Diffuse
Graft vs Host Disease
Immune System Diseases
Connective Tissue Diseases
Skin Diseases
Imatinib Mesylate
Antineoplastic Agents, Immunological
Antineoplastic Agents
Immunologic Factors
Physiological Effects of Drugs
Antirheumatic Agents
Protein Kinase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action