title: Incidence and management of leukopenia/neutropenia in 233 kidney transplant patients following single dose alemtuzumab induction.
abstract: BACKGROUND
  The purpose of this study was to determine the incidence and management strategies for post-transplant leukopenia/neutropenia in kidney recipients receiving alemtuzumab induction during the first year following transplantation.
  
  
  METHODS
  We prospectively identified 233 adult patients who underwent kidney transplantation with alemtuzumab induction at a single institution. The incidence and severity of leukopenia (white blood cell count [WBC] ≤2500/mm(3)) and neutropenia (absolute neutrophil count [ANC] ≤500/mm(3)) were evaluated at 1, 3, 6, and 12 months post-transplantation. We determined any association with cytomegalovirus (CMV) infection, graft rejection, and infections requiring hospitalization. We also reviewed interventions performed, including medication adjustments, treatment with granulocyte stimulating factor, and hospitalization.
  
  
  RESULTS
  The combined incidence of either leukopenia or neutropenia was 47.5% (n = 114/233) with an average WBC nadir of 1700 ± 50/mm(3) at 131.0 ± 8.5 days and an average ANC nadir of 1500 ± 100/mm(3) at 130.4 ± 9.6 days. No significant difference in graft rejection, CMV infection, or infections requiring hospitalization was found in the leukopenia/neutropenia group vs the normal WBC group (P = .3). The most common intervention performed for leukopenia/neutropenia group was prophylactic medication adjustment. Six patients (5.2%) required a change in >1 medication. The majority of these patients also required granulocyte stimulating factor (61.5%; 32/52), with an average of 2.5 doses given. A total of 25 patients (21.9%) required hospitalization due to leukopenia/neutropenia with an average length of stay of 6 days.
  
  
  CONCLUSIONS
  Kidney transplant patients receiving alemtuzumab induction required significant interventions due to leukopenia/neutropenia in the first year post-transplantation. These results suggest the need for additional studies aimed at defining the optimum management strategies of leukopenia/neutropenia in this population.
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, United States.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana, United States.
authors.forename: R
authors.initials: R
authors.lastname: Couvillion
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States.
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States.
authors.forename: M
authors.initials: M
authors.lastname: Killackey
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States.
authors.forename: J
authors.initials: J
authors.lastname: Buell
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States.
authors.forename: B
authors.initials: B
authors.lastname: Lee
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States.
authors.forename: B H
authors.initials: BH
authors.lastname: Saggi
authors.affiliation: Tulane University School of Medicine, Tulane Abdominal Transplant Institute, New Orleans, Louisiana, United States. Electronic address: aparames@tulane.edu.
authors.forename: A S
authors.initials: AS
authors.lastname: Paramesh
mesh_terms: D000074323:Alemtuzumab; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects; D007958:Leukocyte Count; D007970:Leukopenia / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced*; D011183:Postoperative Complications / Q000139:chemically induced* / Q000453:epidemiology
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab