Laros-van Gorkom B A P, Huisman C A M, Wijermans P W, Schipperus M R
Department of Haematology, Haga Hospital, location Leyenburg, The Hague, the Netherlands.
Neth J Med. 2007 Oct;65(9):333-8.
Alemtuzumab (MabCampath) is a monoclonal antibody against CD52, indicated as third-line treatment of chronic lymphocytic leukaemia (CLL). As most important side effect opportunistic infections are mentioned. It is, however, unknown whether these complications often lead to problems in general patient care in the Netherlands.
To gain insight into the use and complications of alemtuzumab therapy, the alemtuzumab-treated CLL patients in 15 hospitals in the Netherlands were evaluated by means of a questionnaire.
In the period from 31 October 2001 until 17 November 2005, 27 patients with CLL or prolymphocytic leukaemia (PLL), RAI stage I to IV, Binet stage A to C, received 32 treatments with alemtuzumab. The time from diagnosis until start of alemtuzumab treatment was 6 +/- 4.5 years (mean +/- SD ). The treatment lasted 11 +/- 7 weeks. Of the treatments, 41% could be administered for the full 12 weeks. The most frequent adverse events were fever (72%), shivering (47%), fatigue (22%) and dyspnoea (16%). Haematological side effects consisted of leucopenia (75%), thrombocytopenia (44%), and anaemia (13%). Infectious complications occurred in 12 of 32 (38%) treatments: pneumonia (25%; of which one Pneumocystis carini pneumonia and four Aspergillus infections), sepsis (9%; of which one Listeria), herpes zoster (9%), herpes simplex (6%), CMV reactivation (6%), meningitis (3%) and Guillain Barre (3%). The overall response was 53%, with complete remission in 13%, partial remission in 41%, stable disease in 25% and progressive disease in 13%, and lasted for 8.3 +/- 7.3 months.
Treatment with alemtuzumab is often terminated prematurely, leading to a suboptimal treatment effect. Fear of severe uncontrollable opportunistic infections seems unjustified.
阿仑单抗（MabCampath）是一种抗CD52单克隆抗体，被用作慢性淋巴细胞白血病（CLL）的三线治疗药物。其最重要的副作用为机会性感染。然而，在荷兰这些并发症是否经常给患者的整体护理带来问题尚不清楚。
为深入了解阿仑单抗治疗的使用情况及并发症，通过问卷调查对荷兰15家医院接受阿仑单抗治疗的CLL患者进行了评估。
在2001年10月31日至2005年11月17日期间，27例CLL或幼淋巴细胞白血病（PLL）患者，RAI分期I至IV期，Binet分期A至C期，接受了32次阿仑单抗治疗。从诊断到开始阿仑单抗治疗的时间为6±4.5年（均值±标准差）。治疗持续11±7周。其中41%的治疗能够持续完整的12周。最常见的不良事件为发热（72%）、寒战（47%）、疲劳（22%）和呼吸困难（16%）。血液学副作用包括白细胞减少（75%）、血小板减少（44%）和贫血（13%）。32次治疗中有12次（38%）发生感染并发症：肺炎（25%；其中1例卡氏肺孢子虫肺炎和4例曲霉菌感染）、败血症（9%；其中1例李斯特菌感染）、带状疱疹（9%）、单纯疱疹（6%）、巨细胞病毒再激活（6%）、脑膜炎（3%）和吉兰 - 巴雷综合征（3%）。总体缓解率为53%，完全缓解率为13%，部分缓解率为41%，病情稳定率为25%，病情进展率为13%，缓解持续时间为8.3±7.3个月。
阿仑单抗治疗常常过早终止，导致治疗效果欠佳。对严重且无法控制的机会性感染的担忧似乎并无依据。
