Section of Hematology, Department of Medicine, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 10 avenue Hippocrate, 1200 Brussels, Belgium.
Expert Opin Biol Ther. 2011 Aug;11(8):1099-111. doi: 10.1517/14712598.2011.592824. Epub 2011 Jun 27.
With the use of reduced-intensity conditioning (RIC), early toxicity of allogeneic stem cell transplantation (SCT) has been much reduced. Graft-versus-host disease (GvHD) causes morbidities and mortality. Alemtuzumab is a mAb directed against CD52. When administered prior to transplant, it leads to T-cell depletion. Incorporation of alemtuzumab in RIC results in low rates of GvHD and treatment-related mortality (TRM) in haematological diseases, even in the setting of mismatched-donor transplantation.
The use of alemtuzumab for GvHD prophylaxis in SCT. The benefit of alemtuzumab-based conditioning is partially offset by increased disease relapse due to impaired graft-versus-tumor effect (GvT) and by slower immune reconstitution, necessitating special precautions. While GvHD is prevented with alemtuzumab, post-SCT interventions are often required. Most studies find that alemtuzumab-based conditioning results in decreased chronic GvHD and TRM, but also in decreased progression-free survival. Overall survival after 3 - 5 years is usually equivalent and quality of life may be improved because of a lower incidence of sequelae of chronic GvHD. Many aspects of alemtuzumab treatment are under investigation.
Alemtuzumab reduces GvHD and TRM after SCT. Use of alemtuzumab requires awareness and strict management of the risk of opportunistic infections and of an increased risk of disease recurrence.
随着减强度预处理（RIC）的应用，异基因干细胞移植（SCT）的早期毒性大大降低。移植物抗宿主病（GvHD）导致发病率和死亡率。阿仑单抗是一种针对 CD52 的 mAb。在移植前使用时，它会导致 T 细胞耗竭。阿仑单抗在 RIC 中的应用可导致血液系统疾病的 GvHD 和治疗相关死亡率（TRM）的低发生率，即使在 mismatched-donor 移植的情况下也是如此。
阿仑单抗在 SCT 中的 GvHD 预防作用。阿仑单抗为基础的预处理的益处部分被由于受损的移植物抗肿瘤效应（GvT）和免疫重建较慢而导致的疾病复发增加所抵消，这需要特殊的预防措施。虽然阿仑单抗可预防 GvHD，但移植后常需要干预。大多数研究发现，阿仑单抗为基础的预处理可降低慢性 GvHD 和 TRM，但也会降低无进展生存期。3-5 年后的总生存期通常相当，生活质量可能会因慢性 GvHD 后遗症的发生率降低而提高。阿仑单抗治疗的许多方面正在研究中。
阿仑单抗可降低 SCT 后的 GvHD 和 TRM。使用阿仑单抗需要意识到并严格管理机会性感染的风险，以及疾病复发风险增加的问题。
