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Blood, 15 May 2002, Vol. 99, No. 10, pp. 3554-3561
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Therapeutic role of alemtuzumab (Campath-1H) in patients who have
failed fludarabine: results of a large international study
Michael J. Keating,
Ian Flinn,
Vinay Jain,
Jacques-Louis Binet,
Peter Hillmen,
John Byrd,
Maher Albitar,
Lee Brettman,
Pedro Santabarbara,
Bret Wacker, and
Kanti R. Rai
From the M. D. Anderson Cancer Center, Houston,
TX; Johns Hopkins Institute, Baltimore, MD; Texas Oncology P.A.,
Austin, TX; Hôpital Pitié Salpetrière, Paris,
France; Leeds General Infirmary, Leeds, United Kingdom; Ohio State
University, Columbus; Millennium Pharmaceuticals, Cambridge, MA; Ilex
Oncology, San Antonio, TX; and Long Island Jewish Medical Center, New
Hyde Park, NY.
This study investigated the efficacy, safety, and clinical
benefit of alemtuzumab (Campath-1H) for patients with relapsed or
refractory B-cell chronic lymphocytic leukemia exposed to alkylating agents and having failed fludarabine therapy. Ninety-three patients received alemtuzumab in 21 centers worldwide, with the aim to obtain an
overall response rate of at least 20%. Dosage was increased gradually
(target 30 mg, 3 times weekly, for a maximum of 12 weeks). Infection
prophylaxis was mandatory, beginning on day 8, and continuing for a
minimum of 2 months after treatment. Responses were assessed at weeks
4, 8, and 12, and patients were followed for 34 months. Overall
objective response in the intent-to-treat population (n = 93) was
33% (CR 2%, PR 31%). Median time to response was 1.5 months (range,
0.4-3.7 months). Median time to progression was 4.7 months overall, 9.5 months for responders. At data cut-off, 27 patients (29%) were alive;
overall median survival was 16 months (95% CI: 11.8-21.9) and
32 months for responders. Nineteen responders survived more than 21 months. Clinical benefit was observed both in responders and in
patients with stable disease. The most common adverse events were
related to infusion, generally grade 1 or 2 in severity, occurring
mainly in the first week. Grade 3 or 4 infections were reported in 25 patients (26.9%). However, only 3 (9.7%) of 31 patients who responded
to alemtuzumab treatment developed grade 3 or 4 infections on the
study. Alemtuzumab induced significant responses in these patients with
clinical benefit in the majority and with acceptable toxicity in a
high-risk group.

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