title: Safety and efficacy of alemtuzumab in the treatment of late acute renal allograft rejection.
abstract: Safety and efficacy of alemtuzumab in the treatment of AR in children after renal transplantation is unknown. Five episodes of refractory late AR in three children (three episodes in patient 1 and a single episode in patients 2 and 3 occurring after 7-23 months of transplantation) were treated with one dose of alemtuzumab as a rescue therapy. Four episodes (Banff IA-IB) in patients 1 and 2 reversed fully or partially with alemtuzumab, whereas patient 3 with Banff IB-IIA AR failed to respond. Patient 1 had recurrent AR 5, 13, and 15 months later; first two episodes responded to retreatment with alemtuzumab, and the last episode was not treated causing allograft failure. Patient 2 had steroid-responsive AR after two months and had a functioning allograft 25 months later. A transient reduction in all lymphocyte subsets except natural killer cells occurred in all patients. Patient 3 (treated with steroids, Thymoglobulin(R) , intravenous immunoglobulin, and rituximab prior to alemtuzumab) suffered many bacterial infections during one-yr period after therapy. However, symptomatic viral infections were not observed in any of the children. Treatment with alemtuzumab may prolong allograft survival in multidrug-resistant AR but may not prevent recurrent AR in non-adherent children.
authors: Department of Nephrology, Children's National Medical Center, Washington, DC 20010, USA. dockiranbp@yahoo.com
authors: Kiran
authors: K
authors: Upadhyay
authors: Laurie
authors: L
authors: Midgley
authors: Asha
authors: A
authors: Moudgil
mesh_terms: D000293:Adolescent; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D018432:Drug Resistance, Multiple; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology; D007674:Kidney Diseases / Q000473:pathology; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D013256:Steroids / Q000494:pharmacology; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D013256:Steroids; D000074323:Alemtuzumab