Spectrum of infection, risk and recommendations for prophylaxis and screening among patients with lymphoproliferative disorders treated with alemtuzumab*

Abstract

SummaryThere is an increasing use of monoclonal antibodies in the treatment of haematological malignancies. Alemtuzumab (Campath-1H; Ilex Pharmaceuticals, San Antonio, TX, USA) is a monoclonal antibody reactive with the CD52 antigen used as first and second line therapy for two types of lymphoproliferative disorders: chronic lymphocytic leukaemia (CLL), and T-cell lymphomas [both peripheral (PTCL) and cutaneous (CTCL)]. With alemtuzumab therapy, viral, bacterial and fungal infectious complications are frequent, and may be life threatening. An understanding of the patients at highest risk and duration of risk are important in developing recommendations for empirical management, antimicrobial prophylaxis and targeted surveillance. This review discusses the infection risks associated with these lymphoproliferative disorders and their treatment, and provide detailed recommendations for screening and prophylaxis.

Cutaneous T‐cell lymphoma: 2011 update on diagnosis, risk‐stratification, and management

“…Similar results, with no infectious complications, were recently reported in a small cohort of patients treated with modified, low-dose, subcutaneous alemtuzumab for 6 weeks [321]. In addition to hematologic toxicity, conventionally dosed alemtuzumab in advanced-stage MF/SS is associated with a high incidence of infectious complications [319,320,[322][323][324][325]. Overall, infectious complications have been observed in twothirds of treated patients, most of which are bacterial, including sepsis.…”

A pilot trial of the mTOR (mammalian target of rapamycin) inhibitor RAD001 in patients with advanced B-CLL

“…Drugs like acyclovir and cotrimoxazol have well demonstrated their efficacy in preventing pneumocystis carinii-and varizella zosterassociated infections [27]. Severe infections also occurred in the study by Yee et al when RAD001 was used at a dose of 10 mg/day in patients with hematologic malignancies [14].…”

Low-dose intermittent alemtuzumab in the treatment of Sezary syndrome: clinical and immunologic findings in 14 patients

“…22 Treatment with alemtuzumab is, however, accompanied by severe toxicity, particularly hematologic toxicity (grade 3-4 cytopenias in up to 45% of cases) and an increased risk of infectious complications. 23 In a recent review, the risk of infections in nodal lymphoma/leukemia patients ranged between 23% and 79%; the most common complication was represented by viral infections, particularly cytomegalovirus (CMV) infection, occurring in more than 40% of cases, followed by bacterial sepsis and fungal infections. 23 The risk of infection is increased in advanced disease and in patients heavily pretreated with chemotherapy.…”