Alemtuzumab As Consolidation After a Response to Fludarabine Is Effective in Purging Residual Disease in Patients With Chronic Lymphocytic Leukemia

Abstract

Subcutaneously administered alemtuzumab was effective, safe, and well tolerated as consolidation therapy in patients with CLL who responded to fludarabine induction therapy. Subsequent PBSCT was feasible thereafter.

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

“…Early detection of symptomatic reactivation, along with increased awareness of monitoring techniques and the use of preemptive therapy, has largely improved the management of CMV reactivation. This is evident in the recent report by Montillo and colleagues, in which active CMV infection was prevented with preemptive ganciclovir therapy (or by spontaneous resolution) in patients who developed CMV reactivation [37].…”

“…In particular, the CALGB 10101 study reported six infection-related deaths in patients receiving alemtuzumab consolidation after fludarabine/rituximab induction therapy [32]. It is not immediately clear why infection-related mortality is higher in this trial than in other consolidation trials [37,43,61]. An open issue concerning alemtuzumab consolidation therapy is whether the alemtuzumab dosage should be adjusted according to the level of residual disease after induction therapy.…”

“…Single-agent alemtuzumab is highly effective as both first-line treatment for CLL and treatment for relapsed/ fludarabine-refractory CLL, and has been approved for both indications [24,30]. Alemtuzumab is also being evaluated intensively in the settings of combination therapy [12], consolidation therapy [14,32,37,43,61], and as part of the conditioning regimen for patients undergoing autologous [37] or allogeneic stem cell transplantation (SCT) [10].…”

Low-dose subcutaneous alemtuzumab in refractory chronic lymphocytic leukaemia (CLL): results of a prospective, single-arm multicentre study

“…Alemtuzumab was effective in terms of OR and OS across all biological risk groups, including those with unmutated IgVH genes or 17p-and/or 11q-. 18 Montillo et al 10 showed that low-dose alemtuzumab can be safely used as consolidation therapy in CLL candidates for haematopoietic stem cell autografting, leading to in vivo purging and an improved quality of response to earlier therapy. The patients enrolled in this trial received alemtuzumab 10 mg s.c. three times a week for 6 weeks (cumulative dose 180 mg).…”

“…6,9 Favourable results have also been obtained using much lower cumulative and per dose amounts of the drug, particularly in the setting of maintenance/consolidation therapy. 10 The aim of this article is to update our earlier findings in a smaller cohort of patients 9 concerning the safety and efficacy of subcutaneous low-dose alemtuzumab treatment in patients with refractory CLL. In describing the results of this less aggressive approach to advanced CLL with alemtuzumab monotherapy, this paper will concentrate particularly on patients with adverse prognostic features such as the 17p deletion, an advanced clinical stage, advanced age and fludarabine resistance.…”