II. Background
- Alemtuzumab is no longer commercially available in the U.S. as of 2012
- Still available via a restricted access program
III. Indications
-
Chronic Lymphocytic Leukemia (refractory)
- Alemtuzumab (Campath)
-
Multiple Sclerosis (remitting, not responding to 2 or more disease modifying drugs)
- Alemtuzumab (Lamtrada)
IV. Contraindications
V. Precautions
- Prevaccinate against Varicella Zoster Virus if not immune at least 6 weeks before treatment
- Screen for Tuberculosis before treatment
- Avoid Listeria monocytogenes sources (Deli Meat, unpasteurized milk including derived soft cheese)
VI. Mechanism
- CD52
- Glycoprotein expressed on the surface of most B and T cells, Monocytes, Macrophages and Natural Killer Cells
- Also expressed on some Granulocytes, and male genitourinary tissue
- Anti-CD52 Monoclonal Antibody
- Recombinant human Monoclonal Antibody directed against the CD52 Antigen cell surface marker
- Bind CD52 and triggers a cytotoxic immune response, depleting CD52 positive Cells
VII. Dosing: Multiple Sclerosis
- See other references for disease specific dosing protocols in oncology
-
General
- Monitor for at least 2 hours after each infusion
- Coadministered medications
- Methylprednisolone 1000 mg immediately before infusion
- Herpes Antiviral prophylaxis of at least 2 months after dose (or CD4 Count >200 cells/ml)
-
Multiple Sclerosis
- Course 1
- Give 12 mg/1.2 ml IV infusion over 4 hours daily for 5 consecutive days
- Course 2 (given 12 months after course 1)
- Give 12 mg/1.2 ml IV infusion over 4 hours daily for 3 consecutive days
- Course 1
VIII. Adverse Effects
- Infusion Reactions
- Cerebrovascular Accident
- Secondary Autoimmunity
- Immune Thrombocytopenic Purpura
- Hemolytic Anemia
- Anti-Glomerular Basement Membrane Disease
- Autoimmune Hepatitis
- Secondary Malignancy
- Thyroid Cancer
- Melanoma
- Lymphoproliferative disorders
- Myelosuppression
- Progressive Multifocal Leukoencephalopathy
- Acquired Hemophilia A
IX. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters, Pregnancy category X)
- Use reliable Contraception
- Monitoring (labs at baseline, then monthly, then periodically for 48 months after last dose)
X. Resources
- Alemtuzumab (Lemtrada, DailyMed)
- Alemtuzumab (Campath, DailyMed)