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

Abstract

International audienceInfection is a significant cause of morbidity and death in patients with chronic lymphocytic leukemia (CLL). Increased infectious events may arise from the multiple courses of immunosuppressive therapy and progressive deterioration of a patient's immune system over the course of disease. The humanized, anti-CD52 monoclonal antibody alemtuzumab (Campath or Campath-1H) has shown notable activity for both untreated and fludarabine-refractory CLL. The antibody not only targets malignant cells but also affects normal, healthy immune cells. The cumulative effects of the malignancy and successive courses of treatments adversely impinge on a patient's defense response to certain bacterial, fungal, and viral infections. In this review article, we provide an overview of common infectious events associated with alemtuzumab therapy in CLL. We also discuss recommendations for effectively monitoring and managing infections in CLL patients

Valganciclovir as CMV reactivation prophylaxis in patients receiving alemtuzumab for marrow failure syndromes

“…At the dose used, valganciclovir did not exert any toxic effect on hematopoietic stem cells: hematopoietic recovery was consistent with the response rate and speed expected for such diseases (manuscript in preparation). In conclusion, while fully agreeing with Elter's conclusions that alemtuzumab treatment deserves an adequate management of infectious risk [1], we have shown that a CMV reactivation prophylaxis may allow the use of alemtuzumab in diseases traditionally considered too risky for such a therapy. We provide evidence that oral valganciclovir is effective as anti-CMV prophylaxis in the specific setting of bone marrow failure patients; the optimal duration of treatment as tailored on CD4+ recovery needs to be assessed in larger confirmatory studies.…”

“…Dear Editor, Elter et al recently published in your journal a comprehensive report on the management of infectious risk during treatment by alemtuzumab [1]. Their paper referred exclusively to chronic lymphocytic leukemia patients.…”

“…Alemtuzumab has been scarcely investigated in bone marrow failure syndromes given the specific risk of opportunistic infection from viruses (especially CMV reactivation) and other intracellular pathogens [1,[5][6][7] that would synergize and increase the risk of bacterial complications due to the concomitant neutropenia, especially in SAA. Another concern could be the fear of marrow toxicity deriving from both CMV reactivation and anti-CMV agents.…”

Fludarabine and cyclophosphamide in combination with alemtuzumab in patients with primary high-risk, relapsed or refractory chronic lymphocytic leukemia

“…A third group was constituted of 11 patients treated with VTd (bortezomib-thalidomide-low-dose dexamethasone) for use as comparison, as this group was collected using high-dose cyclophosphamide (hdCyclo). 6,7 We have excluded patients who might have received other bortezomib-based regimens and who were not collected at front line to homogenize our studied population. The median age at collection was 57, 62 and 60 years; sex ratio was 1.64, 1.21 and 1.20; and median weight was 73, 65 and 72 kg for the three groups, respectively.…”

“…over 30 min; premedication, infection prophylaxis and monitoring was performed according to actual standards. 7 Diagnosis and restaging was carried out according to the 1996 National Cancer Institute (NCI) criteria. 8 Of the 61 CLL patients recruited from March 2005 to November 2008 in centers across Germany, four patients did not receive therapy owing to withdrawn consent or revision of diagnosis.…”