title: Intensified alemtuzumab-CHOP therapy for peripheral T-cell lymphoma.
abstract: BACKGROUND
  The prognosis of T-cell lymphoma is poor. To explore the addition of the monoclonal antibody alemtuzumab, we studied the efficacy and tolerability of an intensified alemtuzumab-chemotherapy combination for aggressive T-cell lymphoma in a phase II study by Dutch-Belgian Hemato-Oncology Group (HOVON).
  
  
  METHODS
  Patients (≤65 years) with newly diagnosed T-cell lymphoma received eight CHOP cycles (cyclophosphamide, doxorubicin, vincristine, prednisone) 2-weekly, each cycle with three doses of 30 mg alemtuzumab. Prophylaxis consisted of cotrimoxazole, fluconazole and valaciclovir. Cytomegalovirus (CMV) monitoring took place at least every fortnight.
  
  
  RESULTS
  Twenty patients from 10 centers, median age 50 years, were included. Eighty-five percent received six or more cycles. The overall response was 90% [12 complete remissions (CRs), 1 CR unconfirmed, 5 partial remissions]. Median duration of follow-up of patients still alive was 29 months (range 19-41 months). Median overall survival (OS) and event-free survival (EFS) were 27 and 10 months, with 55%/27% OS/EFS at 2 years. Adverse events consisted of neutropenic fever (n = 8) and CMV reactivation (n = 7), with one CMV disease. Three patients developed secondary Epstein-Barr virus (EBV)-related lymphoma, all after end of treatment.
  
  
  CONCLUSIONS
  Although intensified alemtuzumab-CHOP induces high responses, many patients relapse, and the scheme is associated with serious infection-related adverse events. EBV monitoring after end of treatment is required.
authors.affiliation: Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen. Electronic address: j.c.kluin@int.umcg.nl.
authors.forename: H C
authors.initials: HC
authors.lastname: Kluin-Nelemans
authors.affiliation: Department of Internal Medicine, Isala klinieken, Zwolle.
authors.forename: M
authors.initials: M
authors.lastname: van Marwijk Kooy
authors.affiliation: Department of Hematology.
authors.forename: P J
authors.initials: PJ
authors.lastname: Lugtenburg
authors.affiliation: HOVON Data Center, Erasmus University Medical Center, Rotterdam.
authors.forename: W L J
authors.initials: WLJ
authors.lastname: van Putten
authors.affiliation: HOVON Data Center, Erasmus University Medical Center, Rotterdam.
authors.forename: M
authors.initials: M
authors.lastname: Luten
authors.affiliation: Department of Pathology, Diakonessenhuis, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Oudejans
authors.affiliation: Department of Hematology, University Medical Center Groningen, University of Groningen, Groningen.
authors.forename: G W
authors.initials: GW
authors.lastname: van Imhoff
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000008:administration & dosage; D015996:Survival Rate; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000074323:Alemtuzumab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone