title: Non-bacterial infections in Asian patients treated with alemtuzumab: a retrospective study of the Asian Lymphoma Study Group.
abstract: This retrospective study concerns non-bacterial infections in Asian patients receiving alemtuzumab. The clinical data of 182 patients treated with alemtuzumab alone or alemtuzumab-containing chemotherapy between the years 2003 and 2009 was collected from six Asian countries. Alemtuzumab was used in the setting of frontline (n =48) or salvage (n =90) treatment, and as a part of the conditioning regimen for allogeneic stem cell transplant (n =44). Reactivation of cytomegalovirus (66/182) and varicella zoster virus (25/182), and fungal infection (31/182) including invasive pulmonary aspergillosis, were the most common infectious complications in this retrospective analysis. Thus, we recommend routine prophylaxis with valganciclovir and itraconazole, especially when alemtuzumab is used in the conditioning regimen for allogeneic stem cell transplant. Pneumocystis jirovecii pneumonia (PJP) was found in four patients (3%, 4/122) receiving alemtuzumab as conditioning for stem cell transplant or salvage treatment. Three cases of hepatitis B virus reactivation were found in antigen-negative patients, and 16 cases of tuberculosis were observed. Infection is the major complication of alemtuzumab therapy, and these infectious complications are potentially severe and life-threatening. Based on our retrospective analysis, we have constructed a guideline for antimicrobial prophylaxis in Asian patients receiving alemtuzumab therapy.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Seok Jin
authors.initials: SJ
authors.lastname: Kim
authors.forename: Joon Ho
authors.initials: JH
authors.lastname: Moon
authors.forename: Hawk
authors.initials: H
authors.lastname: Kim
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Yu Yan
authors.initials: YY
authors.lastname: Hwang
authors.forename: Tanin
authors.initials: T
authors.lastname: Intragumtornchai
authors.forename: Surapol
authors.initials: S
authors.lastname: Issaragrisil
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Kwak
authors.forename: Je Jung
authors.initials: JJ
authors.lastname: Lee
authors.forename: Jong Ho
authors.initials: JH
authors.lastname: Won
authors.forename: Arry Harryanto
authors.initials: AH
authors.lastname: Reksodiputro
authors.forename: Soon Thye
authors.initials: ST
authors.lastname: Lim
authors.forename: Ann-Lii
authors.initials: AL
authors.lastname: Cheng
authors.forename: Won Seog
authors.initials: WS
authors.lastname: Kim
authors.forename: Yok Lam
authors.initials: YL
authors.lastname: Kwong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects; D001208:Asia; D002648:Child; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006562:Herpes Zoster / Q000150:complications; D006801:Humans; D008223:Lymphoma / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000379:methods; D033581:Stem Cell Transplantation / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods; D014184:Transplantation, Homologous / Q000379:methods
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab