title: Management guidelines for use of alemtuzumab in B-cell chronic lymphocytic leukemia.
abstract: An expert opinion roundtable held August 8-9, 2002, brought together clinicians with the most extensive experience with the use of alemtuzumab to pool knowledge and develop treatment goals and guidelines for optimal therapy. By sharing our collective experience, we have been able to formulate recommendations for current clinical practice, which are included in this report, and have emphasized results that have implications for future practice. Guidelines for the management of acute "first-dose" events, prophylaxis for infection, detection and treatment of cytomegalovirus reactivation, and hematologic support are presented, with emphasis on allowing patients to proceed smoothly through therapy while maximizing therapeutic benefit. Management of adverse events is facilitated by the predictable timing of their appearance. In general, hematologic adverse events are transient, manageable, and reversible. Clinicians should be cautious of prematurely terminating treatment at 4-6 weeks in patients whose disease responds to treatment. Although resolution of peripheral blood lymphocytosis occurs early in most patients, bone marrow is unlikely to be clear of disease. In particular, grade 4 neutropenia at this time is common and, because it is manageable, it is not an indication to discontinue treatment. The eradication of minimal residual disease from blood and bone marrow observed with alemtuzumab therapy is a major step forward in the treatment of B-cell chronic lymphocytic leukemia. Combination therapies such as alemtuzumab/fludarabine with the potential to maximize eradication at all disease sites should be systematically investigated. Because high response rates and few complications are observed in previously untreated patients, the use of alemtuzumab earlier in therapy may provide optimum benefit to patients.
authors.affiliation: M. D. Anderson Cancer Center, Houston, TX 77030, USA. mkeating@mdanderson.org
authors.forename: Michael
authors.initials: M
authors.lastname: Keating
authors.forename: Stephen
authors.initials: S
authors.lastname: Coutré
authors.forename: Kanti
authors.initials: K
authors.lastname: Rai
authors.forename: Anders
authors.initials: A
authors.lastname: Osterborg
authors.forename: Stefan
authors.initials: S
authors.lastname: Faderl
authors.forename: Ben
authors.initials: B
authors.lastname: Kennedy
authors.forename: Tom
authors.initials: T
authors.lastname: Kipps
authors.forename: Gerald
authors.initials: G
authors.lastname: Bodey
authors.forename: John C
authors.initials: JC
authors.lastname: Byrd
authors.forename: Steven
authors.initials: S
authors.lastname: Rosen
authors.forename: Claire
authors.initials: C
authors.lastname: Dearden
authors.forename: Martin J S
authors.initials: MJ
authors.lastname: Dyer
authors.forename: Peter
authors.initials: P
authors.lastname: Hillmen
mesh_terms: D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects; D017408:Guidelines as Topic; D006801:Humans; D007239:Infections; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy*; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000074323:Alemtuzumab