Long-term efficacy and safety of alemtuzumab in advanced primary cutaneous T-cell lymphomas.
BACKGROUND
Alemtuzumab has been proposed as salvage therapy for refractory cutaneous T-cell lymphomas (CTCLs). Long-term follow-up data are scarce.


OBJECTIVE
To assess the efficacy and safety of alemtuzumab in the treatment of advanced CTCL.


METHODS
A multicentre retrospective analysis was carried out of 39 patients with advanced CTCL treated with alemtuzumab between 2003 and 2013.


RESULTS
Thirty-nine patients (median age 62 years, range 20-83) with Sézary syndrome (SS, n = 23) or advanced mycosis fungoides (MF, n = 16) received alemtuzumab 30 mg two to three times per week for a median duration of 12 weeks (range 1-35). Fifteen patients received maintenance therapy for a median duration of 24 weeks (range 6-277). Eleven patients (28%) had transformed disease (MF, n = 10; SS, n = 1). After a median follow-up of 24 months (range 0.3-124), eight patients (21%) were still alive. The overall response rate was 51% in the whole study group (partial response, n = 13; complete response, n = 7); 70% in patients with SS and 25% in patients with MF (P = 0.009). The median time to progression was 3.4 months (range 0.4-42). Six patients (15%; SS, n = 5; MF, n = 1) remained progression free for > 2 years (median 56 months, range 28-117). Five patients experienced cutaneous large T-cell transformation during alemtuzumab treatment and one patient developed primary cutaneous large B-cell lymphoma. Twenty-four patients (62%) had a grade three or higher infectious adverse event and 10 (26%) a haematological toxicity, which led to treatment discontinuation in 17 cases (44%) and death in two (5%).


CONCLUSIONS
Alemtuzumab may induce long-term remission in SS but seems ineffective in MF and transformed CTCL.
Service de Dermatologie, AP-HP, Hôpital Saint-Louis, 1 Avenue Claude Vellefaux, 75010 Paris, France; INSERM UMR-S976, 'Immunologie, Dermatologie, Oncologie', Université Paris VII, 1 Avenue Claude Vellefaux, 75010 Paris, France.
A
A
de Masson
P
P
Guitera
P
P
Brice
I
I
Moulonguet
F
F
Mouly
J-D
JD
Bouaziz
M
M
Battistella
I
I
Madelaine
J
J
Roux
C
C
Ram-Wolff
J-M
JM
Cayuela
H
H
Bachelez
A
A
Bensussan
L
L
Michel
M
M
Bagot
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; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007271:Injections, Intradermal; D007275:Injections, Intravenous; D008134:Long-Term Care; D016410:Lymphoma, T-Cell, Cutaneous / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009182:Mycosis Fungoides / Q000188:drug therapy; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*; D055815:Young Adult
D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000074323:Alemtuzumab