Anti-CD20 therapy and autoimmune disease: therapeutic opportunities and evolving insights

Based on the successful clinical experience with the anti-CD20 antibody, rituximab, for the treatment of B-cell non-Hodgkins lymphoma, there is a rapidly growing literature on the treatment of patients with autoimmune diseases with this therapeutic agent. However, the pathogenetic mechanisms responsible for these diseases may differ greatly from those in B cell malignancies. Herein, I provide an overview on recently published clinical experience, and discuss immunobiologic perspectives that are most relevant to understanding the special opportunities and challenges posed by these diseases. Of special importance, there is emerging evidence that the same inherited genetic variations and acquired immunodefects that underlie autoimmune disease pathogenesis may in some patients also interfere with the efficacy of anti-CD20 antibody-based therapy.