Alemtuzumab (Campath-1H) for treatment of lymphoid malignancies in the age of nonmyeloablative conditioning?

Journal article

The anti-CD52 (Campath-1) monoclonal antibodies (Mabs) have a substantial history of use for controlling graft-versus-host disease in allogeneic bone marrow transplantation. Now, with the availability of a humanised form, alemtuzumab (Campath-1H), and the demonstration that this agent can reduce the tumour burden in B-CLL, a new niche may be found - as a potentially curative agent in which its tumour purging ability in vivo combines with its role as a conditioning agent in nonmyeloablative transplantation. Review of the literature shows that alemtuzumab has unique advantages as a method of depleting malignant lymphocytes, including those in patients resistant to conventional chemotherapy. Alemtuzumab can also be used in BMT for depletion of normal T and B lymphocytes of both the recipient and donor for prevention of graft rejection and GVHD. It allows good stem cell recovery with resultant rapid engraftment, has a low risk of EBV-triggered secondary malignancy and does not interfere with blood stem cell mobilisation. As a method of eliminating the malignant clone in B-CLL, alemtuzumab has shown remarkable efficacy in heavily pre-treated patients, a number of whom have progressed to autologous or allogeneic transplantation. Efficacy data are shown within the context of other transplantation data for B-CLL. These results indicate that the combination of tumour-depleting and immunosuppressive properties of alemtuzumab should be explored, with the hope of providing improved treatment options for elderly patients with advanced B-CLL or indolent lymphoma whose prognosis is too poor currently to allow treatment with traditional regimens of high-dose myeloablative chemotherapy.

Authors: Hale, G; Slavin, S; Goldman, J; Mackinnon, S; Giralt, S

• Publication status: Published
• Journal: Bone marrow transplantation
• Volume: 30
• Issue: 12
• Pages: 797-804
• Publication date: 2002-12-01
• DOI: 10.1038/sj.bmt.1703733
• EISSN: 1476-5365
• ISSN: 0268-3369
• Language: English
• Keywords: Treatment Outcome; Female; Humans; Antineoplastic Agents; Cyclophosphamide; Vidarabine; Antibodies, Monoclonal; Graft vs Host Disease; Graft Survival; Middle Aged; Adult; Male; Leukemia, Lymphocytic, Chronic, B-Cell; Lymphocyte Depletion; Aged; Antineoplastic Combined Chemotherapy Protocols; Antibodies, Neoplasm; Lymphoma; Survival Analysis; Bone Marrow Purging; Transplantation Conditioning; Antibodies, Monoclonal, Humanized; Bone Marrow Transplantation