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Bezares R, Stemmelin G, Argentieri D, Lanari E, Guy-Garay E, Campestri R, Bartomioli M, García J, Giralt S, Milone G. Subcutaneous alemtuzumab in patients with refractory/relapsed B-CLL after a fludarabine-based regimen. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.6600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6600 Background: Alemtuzumab is the only immunotherapy that is effective as a single agent in patients with B-CLL who are refractory to, or who have relapsed after, fludarabine therapy. The optimized schedule for alemtuzumab that achieves maximal efficacy with manageable toxicity is still being explored. We report the first interim analysis of a new, less intensive schedule of alemtuzumab SC to patients with refractory/relapsed B-CLL. Methods: Alemtuzumab was dose escalated from 10 to 20 mg during the first week, 30 mg bid during the second and third weeks, and 30 mg once weekly during weeks 4, 6, 8, 10, 12, 16, 20, 24, 28, 34, and 40. Antiviral prophylaxis included TMP/SMX bid 3 times a week and acyclovir 200 mg tid. Results: Patients (N = 36) with refractory (19%) or relapsed (81%) B-CLL had a median age of 67 years (range, 43–86 years), 28 were male, 61%/39% had Binet stage B/C disease, and 2 had B-cell prolymphocytic transformation. The median number of prior therapies was 1 (range, 1–4). The median duration of treatment was 7 weeks (range, 2–24 weeks), with a median cumulative alemtuzumab dose of 412 mg (range, 150–1,080 mg). Thirty-two patients were evaluable for response. The overall response rate of 93%: complete response (CR), 34%; unconfirmed CR, 6%; partial response (PR), 53%. Two patients (7%) did not respond to therapy. Of the 7 refractory patients, 5 had a PR, 1 did not respond, and 1 was not yet evaluable. Median overall survival was 10 months, which correlated with response and pretreatment status. Minimal residual disease (MRD) was measured by flow cytometry in 5 patients who achieved a CR: 3 patients had <0.5% of CD5/CD19/CD23+ cells, 1 patient had <5% of CLL cells, and 1 patient had <10% CLL cells. According to WHO toxicity criteria, 5 patients experienced grade 3/4 infection; 2 patients had grade 3 granulocytopenia/thrombocytopenia; 1 patient had cytomegalovirus (CMV) reactivation without CMV disease; and 1 patient developed Epstein-Barr Virus with prolonged bone marrow hypoplasia. Conclusions: Results of this interim analysis suggest that a less intense regimen of alemtuzumab is feasible, effective, and safe for patients with refractory/relapse B-CLL after fludarabine therapy. No significant financial relationships to disclose.
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Affiliation(s)
- R. Bezares
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - G. Stemmelin
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - D. Argentieri
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - E. Lanari
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - E. Guy-Garay
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - R. Campestri
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - M. Bartomioli
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - J. García
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - S. Giralt
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
| | - G. Milone
- Hospital General de Agudos, Ciudad de Buenos Aires, Argentina; Hospital Britanico, Buenos Aires, Argentina; Sanatorio Mitre, Buenos Aires, Argentina; Centro Medico Corrientes, Buenos Aires, Argentina; CEMIC, Buenos Aires, Argentina; Hospital Pena Bahia Blanca, Buenos Aires, Argentina; Hospital Privado de Cordova, Cordova, Argentina; M. D. Anderson Cancer Center, Houston, TX; Fundaleu, Buenos Aires, Argentina
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