Treatment of chronic graft-versus-host disease with clofazimine
SJ Lee, SA Wegner, CJ McGarigle, BE Bierer and JH Antin
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115,
USA.
Clofazimine (Lamprene) is an antimycobacterial drug that has
antiinflammatory activity in a number of chronic autoimmune skin disorders.
We report 22 patients treated with clofazimine for chronic
graft-versus-host disease (cGVHD). The initial dose was 300 mg orally in a
single daily dose for 90 days. After 90 days, the dose was lowered to 100
mg orally each day and the medication continued indefinitely as tolerated.
Treatment courses lasted 7 to 835 days and were generally well tolerated.
Gastrointestinal side effects occurred in eight of 22 patients (36%) and
hyperpigmentation was noted in 12 of 22 patients (55%), which resolved upon
decrease or discontinuation of the drug. Over 50% of patients with skin
involvement, flexion contractures, or oral manifestations achieved complete
or partial responses. Seven of 22 patients (32%) were able to reduce other
immunosuppressive medications. Thus, clofazimine is safe and has
encouraging efficacy in cGVHD, particularly if sclerodermatous skin, joint
contractures, or oral manifestations are present. The mechanism by which
clofazimine induces a response is unknown, but might be secondary to
suppression of alloreactive T-cell function in cGVHD target organs.
Clofazimine deserves further study for the treatment of cGVHD.
Volume 89,
Issue 7,
pp. 2298-2302,
04/01/1997
Copyright © 1997 by The American Society of Hematology
