Alemtuzumab

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Contents

[edit] BRAND NAMES

[edit] MECHANISM OF ACTION

Alemtuzumab is a CD52-directed cytolytic antibody. It binds to CD52, a cell surface antigen present on lymphocytes T and B, and to a lesser extent on other immune cells.

Following cell surface binding to T and B lymphocytes, alemtuzumab results in antibody-dependent cellular cytolysis and their rapid depletion from circulation.

[edit] INDICATIONS

  • treatment of B-cell chronic lymphocytic leukemia (B-CLL) (Campath, MabCampath). It is used as second-line therapy in patients who have been treated with alkylating agents and who have failed fludarabine therapy.
  • treatment of multiple sclerosis (Lemtrada). In phase III trials, Alemtuzumab was shown to be more effective than a current first-line treatment, subcutaneous interferon beta-1a, in decreasing relapse rate in treatment-naïve and previously treated patients and in decreasing disability progression in previously treated patients.[1]

[edit] DOSAGE

[edit] DOSAGE FORMS AND STRENGTHS

  • 30 mg/1 mL single use vial (Campath)
  • Injection: 12 mg/1.2 mL (10 mg/mL) in a single-use vial (Lemtrada)

[edit] CONTRAINDICATIONS

Alemtuzumab is contraindicated in patients who have active systemic infections, underlying immunodeficiency (e.g., seropositive for HIV), or known Type I hypersensitivity or anaphylactic reactions to the substance.

[edit] WARNINGS AND PRECAUTIONS

Alemtuzumab may cause serious side effects:

  • Autoimmune problems such as:
    • Cytopenias (pancytopenia/marrow hypoplasia, immune thrombocytopenic purpura, and hemolytic anemia). The reduced number of platelets in the blood, can make it difficult to stop cuts from bleeding. If a patient using Alemtuzumab notice any signs of bleeding, such as frequent nosebleeds, unexplained bruising, or black and tarry stools, he must notify the doctor as soon as possible.
    • Thyroid Disorders: The use of alemtuzumab necessitate close monitoring of thyroid function and early intervention when abnormalities are developing. About one-quarter of the treated multiple sclerosis patients had a autoimmune reaction against the thyroid gland.
    • Anti-glomerular basement membrane disease and kidney disease.
  • Infusion reactions (See SIDE EFFECTS)
  • Alemtuzumab may increase the risk of infections (bacterial, viral, fungal, and protozoan infections) and reactivate inactive infections.
  • Alemtuzumab may increase the risk of cancer, including thyroid cancer, melanoma and lymphoproliferative disorders
  • Live viral vaccines: Immunization with live viral vaccine should not be used following a course of Alemtuzumab. Patients treated with Alemtuzumab have altered immunity and may be at increased risk of infection following administration of live viral vaccines.

[edit] INTERACTIONS

  • Rituximab: Six infection-related deaths reported after treatment with alemtuzumab following Fludarabine + Rituximab induction in patients with B-Cell Chronic Lymphocytic Leukemia (CLL) [2]

[edit] PREGNANCY AND LACTATION

[edit] SIDE EFFECTS

Most common adverse reactions (≥ 10%) for CAMPATH: cytopenias, infusion reactions, reactivation of cytomegalovirus (CMV), increased risk for opportunistic infections, nausea, emesis, diarrhea, and insomnia.

Most common adverse reactions for LEMTRADA (incidence ≥ 10% and > interferon beta-1a): rash, headache, pyrexia, nasopharyngitis, nausea, urinary tract infection, fatigue, insomnia, upper respiratory tract infection, herpes viral infection, urticaria, pruritus, thyroid gland disorders, fungal infection, arthralgia, pain in extremity, back pain, diarrhea, sinusitis, oropharyngeal pain, paresthesia, dizziness, abdominal pain, flushing, and vomiting.


Alemtuzumab has been associated with infusion-related events including hypotension, rigors, fever, shortness of breath, bronchospasm, chills, and/or rash. In post-marketing reports, the following serious infusion-related events were reported: syncope, pulmonary infiltrates, ARDS, respiratory arrest, cardiac arrhythmias, myocardial infarction and cardiac arrest. The cardiac adverse events have resulted in death in some cases.

Alemtuzumab can precipitate autoimmune disease through the suppression of suppressor T cell populations and/or the emergence of autoreactive B-cells.

[edit] RELATED LINKS

Chronic Lymphocytic Leukemia Treatment Options

[edit] BIBLIOGRAPHY

[edit] REFERENCES

  1. http://www.ncbi.nlm.nih.gov/pubmed/24604792
  2. http://www.cbg-meb.nl/NR/rdonlyres/57657ED4-959D-46F7-A198-FB67FC56B015/0/DHCP20080211_MabCampath_UK.pdf