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Alemtuzumab as first-line therapy for B-cell chronic lymphocytic leukemia: long-term follow-up of clinical effects, infectious complications and risk of Richter transformation

Leukemia volume 20, pages 2204–2207 (2006)Cite this article

Monoclonal antibodies such as alemtuzumab and rituximab have emerged as important new therapeutic agents for B-cell chronic lymphocytic leukemia (B-CLL). Alemtuzumab binds to CD52, an antigen expressed with high density on most normal and malignant B and T lymphocytes.1 Results from a phase II trial of subcutaneous (s.c.) alemtuzumab as first-line therapy for B-CLL showed an overall response (OR) rate of 81%, including seven complete responses (CRs) and 26 partial responses (PRs).2 Notably, the T-cell depletion seems to last longer following first-line alemtuzumab treatment than in patients with advanced B-CLL who had received alemtuzumab as salvage therapy.3, 4 Therefore, long-term follow-up is particularly important to assess any complications that may arise from alemtuzumab-induced immunosuppression. One potential complication is Richter's syndrome (RS), a transformation to a more aggressive lymphoma or leukemia. The prognosis for these patients is poor, with a median survival of 5–8 months from RS diagnosis.5

In this paper, we report the long-term follow-up of patients (n=38) who received s.c. alemtuzumab for up to 18 weeks as first-line therapy for B-CLL in a phase II study.2 The aims were to assess the time to progression and time to treatment failure (TTTF), incidence of late infectious complications and the incidence of RS. The results were compared with consecutive historical controls (n=75) from the same geographical region and who matched the inclusion criteria of the phase II study but received other first-line treatment regimens.

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References

  1. Rossmann ED, Lundin J, Lenkei R, Mellstedt H, Osterborg A . Variability in B-cell antigen expression: implications for the treatment of B-cell lymphomas and leukemias with monoclonal antibodies. Hematol J 2001; 2: 300–306.

    Article  CAS  PubMed  Google Scholar 

  2. Lundin J, Kimby E, Bjorkholm M, Broliden PA, Celsing F, Hjalmar V et al. Phase II trial of subcutaneous anti-CD52 monoclonal antibody alemtuzumab (Campath-1H) as first-line treatment for patients with B-cell chronic lymphocytic leukemia (B-CLL). Blood 2002; 100: 768–773.

    Article  CAS  PubMed  Google Scholar 

  3. Keating MJ, Flinn I, Jain V, Binet JL, Hillmen P, Byrd J et al. Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood 2002; 99: 3554–3561.

    Article  CAS  PubMed  Google Scholar 

  4. Lundin J, Porwit-MacDonald A, Rossmann ED, Karlsson C, Edman P, Rezvany MR et al. Cellular immune reconstitution after subcutaneous alemtuzumab (anti-CD52 monoclonal antibody, CAMPATH-1H) treatment as first-line therapy for B-cell chronic lymphocytic leukaemia. Leukemia 2004; 18: 484–490.

    Article  CAS  PubMed  Google Scholar 

  5. Tsimberidou A-M, Keating MJ . Richter's syndrome: biology, incidence, and therapeutic strategies. Cancer 2005; 103: 216–228.

    Article  CAS  PubMed  Google Scholar 

  6. Cheson BD, Bennet JM, Grever M, Kay N, Keating MJ, O'Brien S et al. National Cancer Institute-sponsored Working Group guidelines for chronic lymphocytic leukaemia: revised guidelines for diagnosis and treatment. Blood 1996; 87: 4990–4997.

    CAS  PubMed  Google Scholar 

  7. Thursky KA, Worth LJ, Seymour JF, Prince MH, Slavin M . Spectrum of infection, risk and recommendations for prophylaxis and screening among patients with lymphoproliferative disorders treated with alemtuzumab. Br J Haematol 2005; 132: 3–12.

    Article  Google Scholar 

  8. Robak T, Blonski JZ, Gora-Tybor J, Kasznicki M, Konopka L, Ceglarek B et al. Second malignancies and Richter's syndrome in patients with chronic lymphocytic leukaemia treated with cladribine. Eur J Cancer 2004; 40: 383–389.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

This study was supported by grants from the Swedish Cancer Society, The Cancer Society in Stockholm, The Cancer and Allergy Foundation, The Stockholm County Council and The Karolinska Institutet Foundations.

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Author notes

  1. C Karlsson and S Norin: These authors have contributed equally to this work

Authors and Affiliations

  1. Departments of Hematology, Oncology and Pathology, Karolinska University Hospital, Stockholm, Sweden

    C Karlsson, S Norin, E Kimby, B Sander, A Porwit MacDonald, B Nilsson, E Johansson, H Mellstedt, J Lundin & A Österborg

  2. Department of Oncology/Pathology, Karolinska Institutet, Stockholm, Sweden

    C Karlsson, B Sander, A Porwit MacDonald, B Nilsson, H Mellstedt, J Lundin & A Österborg

  3. Department of Medicine, Karolinska Institutet, Stockholm, Sweden

    S Norin, E Kimby & E Johansson

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  1. C Karlsson
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  2. S Norin
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  3. E Kimby
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  8. H Mellstedt
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  9. J Lundin
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  10. A Österborg
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Corresponding author

Correspondence to A Österborg.

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Karlsson, C., Norin, S., Kimby, E. et al. Alemtuzumab as first-line therapy for B-cell chronic lymphocytic leukemia: long-term follow-up of clinical effects, infectious complications and risk of Richter transformation. Leukemia 20, 2204–2207 (2006). https://doi.org/10.1038/sj.leu.2404435

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