An Exploratory Study of the Combination of Monoclonal Antibodies Alemtuzumab and Rituximab in the Treatment of CD52- and CD20-Positive Chronic Lymphoid Disorders

OncologyONCOLOGY Vol 16 No 3
Volume 16
Issue 3

Monoclonal antibodies demonstrate impressive response rates in lymphoid diseases, and treatment indications are expanding. Both alemtuzumab (Campath) (anti-CD52) and rituximab (Rituxan) (anti-CD20) are active in chronic lymphocytic leukemia (CLL) and low-grade lymphomas.

Monoclonal antibodies demonstrate impressive response rates in lymphoiddiseases, and treatment indications are expanding. Both alemtuzumab (Campath)(anti-CD52) and rituximab (Rituxan) (anti-CD20) are active in chroniclymphocytic leukemia (CLL) and low-grade lymphomas. However, activity in somesites (lymph nodes, liver, spleen) is limited. Here, we explore the safety andefficacy of a combination of alemtuzumab and rituximab in patients withrelapsed/refractory hematologic malignancies expressing CD52 and CD20.

Rituximab was given at a dose of 375 mg/m² IV every week × 4 doses.Alemtuzumab was given at a dose of 3, 10, and 30 mg IV on days 3, 4, and 5 ofweek 1, respectively. During weeks 2 through 4, alemtuzumab was given at a doseof 30 mg IV on days 3 and 5 of each week (total of seven 30-mg doses).Trimethoprim and sulfamethoxazole and valacyclovir (Valtrex) were given forprophylaxis.

A total of 31 patients have been treated (18 CLL, 8 CLL/prolymphocyticleukemia [PLL], 2 Richter’s syndrome, 3 mantle cell lymphoma). The median ageis 60 years (range: 42-79 years). The median number of previous treatments is4 (range: 1-8); 17/29 patients (59%) were refractory to fludarabine, 18/28(64%) to alkylators, and 14/27 (52%) to both; and 23/31 patients (74%) were Raistage ³ 3. The median beta-2-microglobulin level was 5.3 mg/dL (range: 2.4-15.8mg/dL). Five patients (2 CLL, 3 CLL/PLL) received two courses.

Toxicities were mainly grade 1/2 and infusion-related. Most frequentlyobserved were fevers and rigors (up to 97% of patients), dyspnea (52%),rash/hives (42%), fatigue (39%), myalgias (35%), and nausea/vomiting (23%).Responses by site (³ 50% improvement at each site) aregiven below:

By National Cancer Institute response criteria,3 patients achieved a complete response (2 CLL,1 CLL/PLL), 10 patients a partial response (7 CLL,3 CLL/PLL), and 1 patient a nodal partial response (CLL), for an overallresponse rate of 45% (14/31 patients). Among responders, the median time toprogression was 7 months (range: 1-12 months) and the median survival was 9months (range: 3-13 months). Infections occurred in 15/31 patients, including5 cytomegalovirus (CMV) antigenemia, 5 pneumonia (1 viral, 2 fungal, 1 bacterial), 1 skin, and 7 fever of unknownorigin.

CONCLUSION: We conclude that the combination of alemtuzumab and rituximab inthis schedule is safe and shows encouraging activity in a poor-prognosis groupof patients.

Related Videos
Patients with CML can become an active part of their treatment plan by discussing any questions that come to mind with their providers.
A panel of 4 experts on multiple myeloma
Video 1 - 4 KOLs are featured in "Treating Patients Referred to Academic Centers for CAR T"
Video 1 - 4 KOLs are featured in "Identifying Potential Candidates for CAR T-Cell Therapy"
Beth Faiman, CNP, PhD, an expert on multiple myeloma
Jorge E. Cortes, MD, emphasizes proper communication between patients with chronic myeloid leukemia and their providers during the treatment course.
Dietary interventions or other medications may help mitigate diarrhea in patients who undergo therapy for chronic myeloid leukemia.
Considering notable adverse effects associated with treatment may be critical when selecting therapy options for those with CML.
Related Content