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Cellular immune reconstitution after subcutaneous alemtuzumab (anti-CD52 monoclonal antibody, CAMPATH-1H) treatment as first-line therapy for B-cell chronic lymphocytic leukaemia

Abstract

Little information is available on long-term immune reconstitution after therapy with alemtuzumab in B-CLL patients. We present long-term follow-up data for blood lymphocyte subsets analysed by flow cytometry in previously untreated B-CLL patients who received alemtuzumab subcutaneously as first-line therapy. All lymphoid subsets were significantly (P<0.001) and profoundly reduced; the median end-of-treatment counts for CD4+, CD8+, CD356+ (natural killer (NK)), CD3+56+ (NK–T) and CD19+5 (normal B) cells were 43, 20, 4, 1 and 8 cells/μl, respectively. The median cell count of all subsets remained at <25% of the baseline values for >9 months post-treatment. CD4+ and CD8+ levels in blood had reached >100 cells/μl in >50% of the patients at 4 months after the end of treatment. One patient had a cytomegalovirus reactivation and one patient developed Pneumocystis carinii pneumonia during therapy. No opportunistic or other major infections were recorded during unmaintained, long-term follow-up. There was no correlation between the cumulative dose of alemtuzumab and the severity or length of immunosuppression. CD52 T-cell subsets occurred during the treatment and comprised >80% of all CD4+ and CD8+ cells in the blood at the end of therapy. These subpopulations declined gradually during unmaintained follow-up. The relationship between these observations and the safety/antitumour effects of alemtuzumab is discussed.

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Acknowledgements

The secretarial help of Ms Gerd Ståhlberg is highly appreciated. This study was approved by the Ethics Committee of Karolinska Institutet, and conducted in accordance with the declaration of Helsinki. The study was supported by the Swedish Cancer Society, the Cancer Society in Stockholm, the Torsten and Ragnar Söderberg Foundation, Schering AG, Berlin, Germany and Ilex Oncology Inc., San Antonio, TX, USA.

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Correspondence to A Österborg.

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Lundin, J., Porwit-MacDonald, A., Rossmann, E. et al. Cellular immune reconstitution after subcutaneous alemtuzumab (anti-CD52 monoclonal antibody, CAMPATH-1H) treatment as first-line therapy for B-cell chronic lymphocytic leukaemia. Leukemia 18, 484–490 (2004). https://doi.org/10.1038/sj.leu.2403258

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