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Alemtuzumab in Previously Treated Chronic Lymphocytic Leukemia Patients Who Also Had Received Fludarabine

From the Long Island Jewish Medical Center, New Hyde Park, NY; Georgetown University Medical Center, Lombardi Cancer Center, Washington, DC; Marshfield Clinic, Marshfield, WI; Wake Forest University Baptist Medical Center, Winston-Salem, and University of North Carolina at Chapel Hill, Chapel Hill, NC; University of Pennsylvania Medical Center, Philadelphia, PA; Ilex Oncology, San Antonio, TX; and Millennium Pharmaceuticals, Cambridge, MA.

This work was presented in part at the Forty-Second Annual Meeting of the American Society of Hematology, San Francisco, CA, December 1-5, 2000.Address reprint requests to K.R. Rai, Long Island Jewish Medical Center, New Hyde Park, New York, NY 11040; email: rai{at}lij.edu

PURPOSE: This phase II pilot study determined the efficacy and safety of alemtuzumab (Campath-1H; Burroughs Wellcome, United Kingdom) in patients with chronic lymphocytic leukemia (CLL), all of whom had previously received fludarabine and other chemotherapy regimens.

PATIENTS AND METHODS: Twenty-four patients were treated with intravenous alemtuzumab at six centers in the United States. The target dose of 30 mg over 2 hours, three times weekly, was administered for up to 16 weeks. Responses were evaluated by an independent panel of experts using 1996 National Cancer Institute–sponsored Working Group criteria. Safety assessments included analysis of lymphocyte subpopulations. Antimicrobial prophylaxis was not mandatory.

RESULTS: Eight patients (33%) achieved a major response (all partial remissions), with a median time to response of 3.9 months (range, 1.6 to 5.3 months). The median duration of response was 15.4 months (range, 4.6 to 38.0 months), the median time to disease progression was 19.6 months (range, 7.7 to 42.0 months), and the median survival time was 35.8 months (range, 8.8 to 47.1 months). Acute infusion-related events, mainly grades 1 and 2, were most common and most severe in the first week. Ten patients (eight nonresponders and two responders) experienced major infections on-study. Pneumocystis carinii pneumonia was reported in two patients on-study; neither had received prophylaxis. Median CD4⁺ and CD8⁺ counts decreased and then began to increase by the end of the study, with further recovery by 1-month follow-up. One of 53 samples obtained from 10 patients had a low titer of alemtuzumab antibodies.

CONCLUSION: Alemtuzumab has significant activity in poor-prognosis, fludarabine-treated CLL patients. However, because of a relatively high incidence of opportunistic infections accompanying profound lymphopenia, future protocols should include mandatory prophylaxis.

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