Alemtuzumab in Relapsed or Refractory Chronic Lymphocytic Leukemia and Prolymphocytic Leukemia

Abstract

Twenty-three adult patients with relapsed or refractory chronic lymphocytic leukemia (CLL) or prolymphocytic leukemia (PLL) were treated for up to 12 weeks with the anti-CD52 monoclonal antibody alemtuzumab. Patients were a median of six years from diagnosis and had been treated with a median of four chemotherapy regimens (median of 24 total cycles) prior to enrollment. Fourteen patients (61%) had received prior monoclonal antibody therapy with rituximab. Adverse symptoms were primarily mild to moderate fever, rigor/chills, nausea/vomiting, or fatigue/malaise in up to 86% of patients. Patients with low blood counts at the initiation of alemtuzumab tolerated therapy well. A total of 17 patients were evaluable for disease response. Nine patients (53%) responded with complete remissions in the peripheral blood. Of these nine, five were evaluated by bone marrow biopsy with four complete responses (CR) and one partial response. Six of the nine presented with nodal disease at the start of alemtuzumab therapy with three CRs and three partial responses. Alemtuzumab is a monoclonal antibody that offers effective treatment for chemotherapy refractory CLL and PLL and is generally well tolerated in the outpatient setting.

Alemtuzumab in clinical practice: A British Columbia experience

“…Consistent with the literature, intravenous administration was associated with a higher rate of drug reactions including rash, hypotension, and dyspnea. Unlike previous studies, which predominately employed intravenous delivery [7,9,11,18,19], a majority of our patients received alemtuzumab subcutaneously. Although injection reactions were commonly seen with the subcutaneous route, they tended to be mild and resolved after the first few weeks.…”

“…Information regarding its safety and efficacy has been derived mainly from clinical trials for fludarabine refractory patients with CLL [7,9,18,19]. In this study, we assessed the efficacy and adverse effects of alemtuzumab monotherapy in 42 consecutive patients treated in BC over a 4 year period.…”

Red cell aplasia and autoimmune hemolytic anemia following immunosuppression with alemtuzumab, mycophenolate, and daclizumab in pancreas transplant recipients

“…RCA, AIHA, and fatal ITP have been reported as complications of alemtuzumab in the treatment of CLL. [33][34][35] In addition, there is a report of one case of AIHA in a kidney transplant recipient (who did not suffer from CLL) after induction with alemtuzumab.…”

Homing and mobilization of hematopoietic stem cells and hematopoietic cancer cells are mirror image processes, utilizing similar signaling pathways and occurring concurrently: circulating cancer cells constitute an ideal target for concurrent treatment with chemotherapy and antilineage-specific antibodies

“…Also, continuous adjuvant treatment with antilineage-specific antibodies should work effectively to maintain patients in complete remission by reducing the process of spreading to new sites. Indeed, recent reports indicate that treatment of CLL patients with Campath-1H is effective in reducing tumor burden 165,166 and more so when used concurrently with fludarabine. 167,168 However, in the high doses currently used, Campath-1H is toxic as single agent or in combination with chemotherapy in CLL patients and particularly in NHL patients.…”