title: Alemtuzumab in chronic lymphocytic leukemia: final results of a large observational multicenter study in mostly pretreated patients.
abstract: This retrospective study evaluated the benefit of alemtuzumab monotherapy in unselected patients with advanced B-cell chronic lymphocytic leukemia (CLL) and prolymphocytic leukemia (B-PLL) to definitely describe the impact of this antibody in clinical routine use. Data were collected from 208 consecutive, mainly pretreated, patients with CLL (n = 202), and B-PLL (n = 6) who had received alemtuzumab. Response, progression-free survival (PFS), and overall survival (OS) in various settings were assessed, and toxicities were documented. In these routine patients, a comparably low cumulative dose of alemtuzumab (median, 403 mg) was applied. In CLL, overall response rate was 32 %, and various pre-therapeutic parameters were predictive for inferior response, among them, the prior administration of ≥3 therapy lines (P < 0.001), refractoriness to fludarabine (P = 0.002), and bulky lymphadenopathy (P = 0.003). PFS and OS after start of alemtuzumab were 6.2 and 21.0 months, respectively. Bulky lymphadenopathy was the prominent risk factor for both inferior PFS (P < 0.001) and OS (P = 0.002). In B-PLL, four patients experienced a fatal outcome, whereas two patients had some benefit with alemtuzumab. The main adverse effects were CMV reactivation (20 %) and a broad spectrum of infections, which together were the main reasons for treatment interruption and/or premature termination. In conclusion, alemtuzumab administered even at low dose levels was effective but overall considerably toxic in routine CLL patients. We emphasize that alemtuzumab remains an important therapeutic option in subsets of CLL patients.
authors.affiliation: Department of Internal Medicine V (Hematology and Oncology), Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria, michael.fiegl@i-med.ac.at.
authors.forename: M
authors.initials: M
authors.lastname: Fiegl
authors.forename: R
authors.initials: R
authors.lastname: Stauder
authors.forename: M
authors.initials: M
authors.lastname: Steurer
authors.forename: M
authors.initials: M
authors.lastname: Mian
authors.forename: G
authors.initials: G
authors.lastname: Hopfinger
authors.forename: Y
authors.initials: Y
authors.lastname: Brychtova
authors.forename: C
authors.initials: C
authors.lastname: Skrabs
authors.forename: A
authors.initials: A
authors.lastname: Zabernigg
authors.forename: F
authors.initials: F
authors.lastname: Schmid
authors.forename: F
authors.initials: F
authors.lastname: Haslbaur
authors.forename: G
authors.initials: G
authors.lastname: Winder
authors.forename: A
authors.initials: A
authors.lastname: Walder
authors.forename: A
authors.initials: A
authors.lastname: Lang
authors.forename: D
authors.initials: D
authors.lastname: Voskova
authors.forename: R
authors.initials: R
authors.lastname: Greil
authors.forename: J
authors.initials: J
authors.lastname: Mayer
authors.forename: G
authors.initials: G
authors.lastname: Gastl
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage* / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D004305:Dose-Response Relationship, Drug; D005500:Follow-Up Studies; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D054403:Leukemia, Prolymphocytic, B-Cell / Q000188:drug therapy* / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab