Alemtuzumab for Treatment of Acute Gvhd In Steroid-Refractory Patients

• Published in: Blood 2010-11, Vol.116 (21), p.4545-4545
• Main Authors: Sucupira, Alexandre, Ostronoff, Mauricio, Ostronoff, Fabiana, Maior, ANA Patricia Souto, Freitas, Jose Carlos, Florencio, Rodrigo, Botelho, Luis Fabio, Martins, Monique, Calixto, Rodolfo
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V116.21.4545.4545

Abstract 4545 Acute GVHD is associated with high-mortality. Alemtuzumab is a humanized monoclonal antibody against CD52 and although alemtuzumab has been used in the treatment of steroid-refractory acute GVHD, there is limited data. The severe immunosuppresion caused by alemtuzumab nonetheless is worrisome. We used lower dose of alemtuzumab subcutaneously to reduce the degree of immunosuppresion. Between August 2008 and April 2010, ten patients underwent allo-BMT from matched related donors (7) and unrelated donors (3) developed grade ≥ III, steroid-refractory acute GVHD. Their underlying diagnoses were SAA (3), Hodgkin's lymphoma (3), CML (1), AML (2) and non-Hodgkin's lymphoma (1). Median age was 30 years (range 6 to 45 years), 8 were males and 2 females. Four patients received myeloablative conditioning regimen with busulfan (Bu) and cyclophosphamde and 6 patients received reduced intensity conditioning with Bu and fludarabine/GVHD prophylaxis consisted of cyclosporine A and mycofenolate mofetil. Five patients received bone marrow harvest stem cells from either related donor (4) or unrelated donor (1), 4 received PBSC (3 related and one unrelated) and one received umbilical cord stem cells. All patients developed grade ≥ III acute GVHD. They were initially treated with 2mg of methylprednisolone daily for 5 consecutive days without response. They were then treated with alemtuzumab 10mg/day SQ for 5 consecutive days. The methylprednisolone was reduced to 1mg/kg/day in alternating days. Complete response was considered complete resolution of all manifestation by day 28; partial response if at least one organ target resolved and non response if no regression was seen till D+14. All patients received antibiotics, antifungal treatment and PCP prophylaxis with sulfamethoxazole and anti-CMV/HSV prophylaxis with gancyclovir and acyclovir. The treatment with alemtuzumab SQ was well tolerated. Five patients developed significant hematological toxicities: 4 developed neutropenia (ANC