S Alemtuzumab
ST-segment elevation and acute myocardial dysfunction: case reportA 66-year-old man developed ST-segment elevation and acute myocardial dysfunction during treatment with alemtuzumab.The man, who had a 5 year history of small lymphocytic lymphoma/chronic lymphocytic lymphoma, initially was treated with rituximab and bendamustine, in the study drug CAL101 for 4 months. Subsequently, 2 cycles of fludarabine and cyclophosphamide were administered; prior to admission to the hospital for dyspnea and fever. His treatment was switched to alemtuzumab because of progression of disease.He was given 3mg of alemtuzumab as a test dose [route not stated]. He developed tachycardia, nausea, diaphoresis, vomiting, rigours, and chills, 20 minutes after administration. An ECG showed ST segment elevations. With no observation of chest pain, a thoransthoracic echocardiogram revealed akinesia of the anterior septum, apex, distal anterior wall, and a moderately decreased left ventricular ejection fraction with normal right ventricular size and function.The man was then treated with aspirin, clopidogrel and a continuous heparin infusion, considering possibility of acute myocardial infarction and was followed by cardiac catheterisation. Cardiac catheterisation revealed non-critical occlusive disease. Post-catheterisation ECG showed resolution of ST segment elevations, T-wave inversion and prolongation of corrected QT. Repeat echocardiography, approximately 16 hours after start of alemtuzumab and post-catheterisation showed a left ventricular dysfunction and akinesis of the antero-septum, apex, and distal anterior wall. Ten days after the event, a repeated ECG showed no improvement in wall motion or ejection fraction. Later, he died due to disease progression. An autopsy was not obtained.Author comment: "We report a patient with the diagnosis of small lymphocytic lymphoma/chronic lymphocytic lymphoma, who was treated with a test dose of alemtuzumab and developed acute myocardial dysfunction." Attarian S, et al. Alemtuzumab induced ST-segment elevation and acute myocardial dysfunction. Journal of Cardiology Cases 10: 176-179, No. 5, Nov 2014. Available from: URL: http://doi.
