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Blood, 15 September 2001, Vol. 98, No. 6, pp. 1721-1726
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
High remission rate in T-cell prolymphocytic leukemia
with CAMPATH-1H
Claire E. Dearden,
Estella Matutes,
Bruno Cazin,
Geir E. Tjønnfjord,
Antonio Parreira,
Benet Nomdedeu,
Pietro Leoni,
Fiona J. Clark,
Deepti Radia,
Saad M. B. Rassam,
Tony Roques,
Nicolas Ketterer,
Vasantha Brito-Babapulle,
Martin J. S. Dyer, and
Daniel Catovsky
From the Royal Marsden NHS Trust, London, United
Kingdom; Hopital C. Huriez, Lille, France; National Hospital, Oslo,
Norway; Institute of Oncology, Lisbon, Portugal; Hospital Clinic,
Barcelona, Spain; University of Ancona, Italy; Southampton University
Hospital, Southampton, United Kingdom; Greenwich Hospital, London,
United Kingdom; Queen Mary's Hospital, Sidcup, Kent, United Kingdom;
Worthing Hospital, Sussex, United Kingdom; and Centre of Oncology,
Lausanne, Switzerland.
T-cell prolymphocytic leukemia (T-PLL) is a chemotherapy-resistant
malignancy with a median survival of 7.5 months. Preliminary results
indicated a high remission induction rate with the human CD52 antibody,
CAMPATH-1H. This study reports results in 39 patients with T-PLL
treated with CAMPATH-1H between March 1993 and May 2000. All but 2 patients had received prior therapy with a variety of agents, including
30 with pentostatin; none achieved complete remission (CR). CAMPATH-1H
(30 mg) was administered intravenously 3 times weekly until maximal
response. The overall response rate was 76% with 60% CR and 16%
partial remission (PR). These responses were durable with a median
disease-free interval of 7 months (range, 4-45 months). Survival was
significantly prolonged in patients achieving CR compared to PR or no
response (NR), including one patient who survived 54 months. Nine
patients remain alive up to 29 months after completing therapy. Seven
patients received high-dose therapy with autologous stem cell support,
3 of whom remain alive in CR 5, 7, and 15 months after autograft. Stem
cell harvests in these patients were uncontaminated with T-PLL cells as
demonstrated by dual-color flow cytometry and polymerase chain reaction. Four patients had allogeneic stem cell transplants, 3 from
siblings and 1 from a matched unrelated donor. Two had nonmyeloablative
conditioning. Three are alive in CR up to 24 months after allograft.
The conclusion is that CAMPATH-1H is an effective therapy in T-PLL,
producing remissions in more than two thirds of patients. The use of
stem cell transplantation to consolidate responses merits further study.
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