Infectious complications associated with alemtuzumab treatment

Abstract

13504 Introduction: We report our single institutional experience of ICs associated with alemtuzumab treatment. Methods: Patients (pts) who received alemtuzumab were identified by review of the GUH pharmacy database. All ICs occurring from initiation of alemtuzumab until death or end of follow up as of January 3, 2007 were reviewed and categorized as opportunistic (OI) or non- opportunistic (NOIs). Pts who received hematopoetic stem cell or solid organ transplantation subsequent to alemtuzumab (n=33) or who could not tolerate test doses of alemtuzumab (n=1) were excluded from analysis. Results: Data were reviewed for 16 pts treated with alemtuzumab from February 2003 to September 2006. Median age was 60 years (range 40–78); with 4 females and 12 males. Fifteen pts had chronic lymphocytic leukemia (CLL), and 1 had acute lymphoblastic leukemia (ALL). Median follow-up after starting alemtuzumab treatment was 462 days. Pts with CLL had an average of 2.4 prior treatments (range 1–6). The pt with ALL received alemtuzumab as part of multi-agent intensification chemotherapy regimen. Alemtuzumab was administered subcutaneously, 30 mg three times a week. Median of 29 doses (range 7- 45) were given. Among CLL pts there was 1CR, 8 PRs and 6 PDs (RR 60%). Pneumocystis jirovenci (PCP) and herpersvirus (HSV) prophylaxis was given to 15 (93%) pts. Cytomegalovirus (CMV) surveillance was performed for all. Absolute lymphocyte count (ALC) <1000/μL developed within 5 weeks in 12 (75%) pts. Median ALC at 8 weeks was 155/μL (range 0–18,612). Thirteen OIs were diagnosed in 9 (56%) pts including asymptomatic CMV viremia (n=5), PCP (n=2, one pt did not received PCP prophylaxis), invasive pulmonary aspergillosis (n=2), disseminated histoplasmosis (n=1), localized HSV (n=1), disseminated herpes zoster (n=1), and cerebral acanthamebiasis (n=1). Seven NOIs were noted in 6 pts including bacterial pneumonia, sinusitis, endocarditis and pseudo-membranous colitis. Mortality secondary to ICs was 31%. There was no correlation between ICs and age, duration of lymphoproliferative disorder, number of prior treatments, cumulative dose, response to alemtuzumab, or ALC. Conclusion: Despite adequate prophylaxis, ICs secondary to alemtuzumab are more frequent and diverse than previously reported in clinical trials. No significant financial relationships to disclose.