Alemtuzumab Induction in Lung Transplantation: Time to Move On?

Todd, Jamie L.; Palmer, Scott M.

doi:10.1111/ajt.12825

Cited by 2 publications

(2 citation statements)

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“…Alemtuzumab is labeled for the treatment of B‐cell chronic lymphocytic leukemia, but in the past 12 years has been used off‐label in solid organ transplantation. It has primarily been studied and used for induction immunosuppression and has shown reasonable outcomes when compared to other agents . The immunologic sequelae of repeated alemtuzumab use, such as for rescue, to date have not been described.…”

Section: Discussionmentioning

confidence: 99%

“…Conventional immunosuppression strategies consisting of a calcineurin inhibitor, an antiproliferative agent, and corticosteroids result in 34% of patients experiencing at least one episode of ACR within the first year after transplantation . Controversy exists regarding the therapeutic utility of induction immunosuppression with respect to downregulating ACR events within the first year after transplantation . In fact, nearly half of all lung transplantation recipients do not receive induction immunosuppression as reported to the International Society for Heart and Lung Transplantation Registry (ISHLT) .…”

Section: Introductionmentioning

confidence: 99%

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Rescue alemtuzumab for refractory acute cellular rejection and bronchiolitis obliterans syndrome after lung transplantation

Ensor

Rihtarchik

Morrell

et al. 2017

Clinical Transplantation

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Refractory acute cellular rejection (rACR) is associated with death and bronchiolitis obliterans syndrome (BOS) post-lung transplantation. We report the largest cohort of lung transplant recipients (LTRs) treated with rescue alemtuzumab for rACR or BOS. RACR outcomes included burden of ACR 30 days before and 180 days after rescue assessed by a novel composite rejection standardized score (CRSS, range 0-6) and freedom from ≥A2 ACR. BOS outcomes included freedom from BOS progression and FEV1 decline >10%. Univariate parametric and nonparametric statistical approaches were used to assess treatment response. Kaplan-Meier method with log rank conversion was used to assess freedom from events. Fifty-seven alemtuzumab doses (ACR 40 and BOS 17) given to 51 patients were included. Median time to rescue was 722 (IQR 42-1403) days. CRSS declined significantly (3 vs 0.67, P<0.001) after rescue. Freedom from ≥A2 was 62.5% in rACR. Freedom from BOS progression was 52.9% at 180 days in the BOS cohort. Freedom from FEV1 decline >10% was 70% in BOS grade 1 and 14.3% in advanced BOS grades 2-3. Infections developed in 72.5% and 76.5% of rACR and BOS groups. Rescue alemtuzumab appears useful for rACR. Patients with BOS 1 may have transient benefit, and patients with advanced BOS seem not to respond to alemtuzumab.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%