Phase II study of subcutaneous alemtuzumab without dose escalation in patients with advanced‐stage, relapsed chronic lymphocytic leukaemia

• Published in: British journal of haematology 2009-01, Vol.144 (1), p.78-85
• Main Authors: Karlsson, Claes, Lundin, Jeanette, Kimby, Eva, Kennedy, Ben, Moreton, Paul, Hillmen, Peter, Österborg, Anders
• Format: Article
• Language: English
• Subjects: Alemtuzumab; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal - adverse effects; Antibodies, Monoclonal - therapeutic use; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm - administration & dosage; Antibodies, Neoplasm - adverse effects; Antibodies, Neoplasm - therapeutic use; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Biological and medical sciences; chronic lymphocytic leukaemia; Contusions; Drug Administration Schedule; Erythema; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Immunotherapy; Injections, Subcutaneous; Leukemia, Lymphocytic, Chronic, B-Cell - drug therapy; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicin och hälsovetenskap; Middle Aged; monoclonal antibodies; Pharmacology. Drug treatments; Recurrence; Remission Induction; subcutaneous injection; Thigh; Treatment Outcome
• ISSN: 0007-1048; 1365-2141; 1365-2141
• DOI: 10.1111/j.1365-2141.2008.07451.x

Summary This phase II study (n = 20) aimed to evaluate type, severity and duration of side‐effects and efficacy following subcutaneous (SC) alemtuzumab, without dose‐escalation, in advanced‐stage relapsed chronic lymphocytic leukaemia (CLL) patients. Alemtuzumab 30 and 3 mg was administered SC simultaneously day 1, followed by 30 mg three times per week. Injection‐site‐reactions were recorded every 6–24 h until resolved using National Cancer Institute criteria and a new skin toxicity subscale. The first doses of 30 mg and 3 mg produced injection‐site‐reactions (all but one were grade 1/2) in 13/20 and 9/20 patients, respectively. The second dose (on day 3) resulted in skin‐reactions in 10/20 patients and the third, fourth, fifth and sixth injections produced reactions in 6/20, 1/20, 2/20 and 0/20 patients, respectively. Mild “flu‐like” symptoms occurred during week 1 in 10/20 patients. All side‐effects had subsided by the sixth dose. 15/20 patients (75%) responded (12 partial responses, three complete responses) with a median time‐to‐treatment‐failure of 20 months. Symptomatic cytomegalovirus‐reactivation occurred in 6/20 patients. Two deaths occurred: one bacterial pneumonia and one adenovirus‐infection. The present study showed how to assess cutaneous‐toxicity in detail and that 30 mg alemtuzumab SC administered upfront was well tolerated. Optimized alemtuzumab therapy in properly selected patients may result in high efficacy even in advanced CLL. Our results need to be confirmed in extended studies.