title: Alemtuzumab therapy for hypereosinophilic syndrome and chronic eosinophilic leukemia.
abstract: OBJECTIVE
  Patients with hypereosinophilic syndrome (HES) or chronic eosinophilic leukemia (CEL) that are refractory to standard therapies are difficult to manage and have significantly shortened life expectancy.
  
  
  METHODS
  CD52 is a surface glycoprotein highly expressed on eosinophils. We treated 11 patients with advanced HES/CEL with alemtuzumab, a humanized anti-CD52 monoclonal antibody. Alemtuzumab was administered, in general, first in escalating doses (5, 10, 30 mg i.v. on days 1-3), then at the tolerated dose thrice per week for a total of 12 doses. Patients with complete hematologic response (CHR; normal percent and absolute eosinophil count) were allowed to continue therapy once weekly as maintenance.
  
  
  RESULTS
  Ten patients (91%) achieved CHR after a median of 2 weeks (0.5-5 weeks) of therapy. Bone marrow eosinophilia resolved in four of seven evaluable patients. The median duration of CHR was 3 months (1.5-17+ months). Seven of the 10 CHR patients relapsed, five while off-therapy. Two patients achieved second CHR upon alemtuzumab rechallenge. Three patients experienced mild infusion-related symptoms, two developed cytomegalovirus reactivation requiring therapy, and one developed orbital lymphoma that was successfully treated.
  
  
  CONCLUSIONS
  Our limited experience suggests alemtuzumab to be a valuable therapy for advanced HES or CEL, refractory to standard therapies, and supports the clinical evaluation of alemtuzumab in a larger trial.
authors.affiliation: Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. sverstov@mdanderson.org
authors.forename: Srdan
authors.initials: S
authors.lastname: Verstovsek
authors.forename: Ayalew
authors.initials: A
authors.lastname: Tefferi
authors.forename: Hagop
authors.initials: H
authors.lastname: Kantarjian
authors.forename: Taghi
authors.initials: T
authors.lastname: Manshouri
authors.forename: Raja
authors.initials: R
authors.lastname: Luthra
authors.forename: Animesh
authors.initials: A
authors.lastname: Pardanani
authors.forename: Alfonso
authors.initials: A
authors.lastname: Quintás-Cardama
authors.forename: Farhad
authors.initials: F
authors.lastname: Ravandi
authors.forename: Pat
authors.initials: P
authors.lastname: Ault
authors.forename: Carlos
authors.initials: C
authors.lastname: Bueso-Ramos
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Cortes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage / Q000627:therapeutic use*; D001853:Bone Marrow / Q000473:pathology; D004334:Drug Administration Schedule; D004341:Drug Evaluation; D004804:Eosinophils; D005260:Female; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000074323:Alemtuzumab