Guidelines for alemtuzumab treatment in chronic lymphocytic leukaemia (CLL)

Czech version

Authors: Pracovní Skupina České Cll Skupiny (čscll) České Hematologické Společnosti České Lékařské Společnosti J. E. Purkyně L. Smolej ¹; V. Procházka ²; M. Špaček ³; P. Obrtlíková ⁴; J. Gumulec ⁵; S. Vokurka ⁶; M. Doubek ⁷
Authors‘ workplace: Oddělení klinické hematologie II. interní kliniky Lékařské fakulty UK a FN Hradec Králové, přednosta prof. MUDr. Jaroslav Malý, CSc. ¹; Hemato-onkologická klinika Lékařské fakulty UP a FN Olomouc, přednosta prof. MUDr. Karel Indrák, DrSc. ²; Oddělení klinické hematologie FN Královské Vinohrady Praha, přednosta doc. MUDr. Tomáš Kozák, Ph. D., MBA. ³; I. interní klinika 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Marek Trněný, CSc. ⁴; Ústav klinické hematologie FN Ostrava, přednosta prim. MUDr. Jaromír Gumulec ⁵; Hematologicko-onkologické oddělení FN Plzeň, přednosta prim. MUDr. Vladimír Koza ⁶; Interní hematologická a onkologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jiří Mayer, CSc. ⁷
Published in: Vnitř Lék 2012; 58(3): 232-236
Category: Guidelines

Overview

Alemtuzumab, the humanized monoclonal anti-CD52 antibody, is an effective agent in the treatment of fludarabine-refractory chronic lymphocytic leukemia (CLL). Due to many specific issues associated with alemtuzumab treatment, the Working Committee of Czech CLL Study Group developed these guidelines. Summary of recommendations: (1) The main indication of alemtuzumab is fludarabine-refractory CLL. (2) Further possible indications include first-line treatment (in patients who cannot be treated by fludarabine-containing regimens), therapy of patients with del 17p, treatment of refractory autoimmune cytopenias and management of patients with severe cytopenias due to bone marrow infiltration. (3) The treatment should last 12 weeks and should not be terminated prematurely if there are no signs of CLL progression; bone marrow aspirate/biopsy can be performed after 12 weeks of treatment. (4) Subcutaneous administration of alemtuzumab seems to be equally effective with advantageous reduction of infusion-related adverse events. (5) Patients treated with alemtuzumab must receive combined antimicrobial prophylaxis against Pneumocystis jiroveci and herpetic viruses. Cytomegalovirus viremia should be monitored using weekly PCR from peripheral blood. (6) Use of alemtuzumab in combinations and consolidation/maintenance protocols must be considered experimental and needs optimization within prospective clinical trials. (7) Alemtuzumab treatment should be conducted by an experienced hematologist within a center of intensive hematology care.

Key words:
chronic lymphocytic leukemia – alemtuzumab – p53 – fludarabin – refractory CLL – recommendations

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