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The anti-CD52 (Campath-1) monoclonal antibodies (Mabs) have a substantial history of use for controlling graft-versus-host disease in allogeneic bone marrow transplantation. Now, with the availability of a humanised form, alemtuzumab (Campath-1H), and the demonstration that this agent can reduce the tumour burden in B-CLL, a new niche may be found - as a potentially curative agent in which its tumour purging ability in vivo combines with its role as a conditioning agent in nonmyeloablative transplantation. Review of the literature shows that alemtuzumab has unique advantages as a method of depleting malignant lymphocytes, including those in patients resistant to conventional chemotherapy. Alemtuzumab can also be used in BMT for depletion of normal T and B lymphocytes of both the recipient and donor for prevention of graft rejection and GVHD. It allows good stem cell recovery with resultant rapid engraftment, has a low risk of EBV-triggered secondary malignancy and does not interfere with blood stem cell mobilisation. As a method of eliminating the malignant clone in B-CLL, alemtuzumab has shown remarkable efficacy in heavily pre-treated patients, a number of whom have progressed to autologous or allogeneic transplantation. Efficacy data are shown within the context of other transplantation data for B-CLL. These results indicate that the combination of tumour-depleting and immunosuppressive properties of alemtuzumab should be explored, with the hope of providing improved treatment options for elderly patients with advanced B-CLL or indolent lymphoma whose prognosis is too poor currently to allow treatment with traditional regimens of high-dose myeloablative chemotherapy.

Original publication

DOI

10.1038/sj.bmt.1703733

Type

Journal article

Journal

Bone Marrow Transplant

Publication Date

12/2002

Volume

30

Pages

797 - 804

Keywords

Adult, Aged, Alemtuzumab, Antibodies, Monoclonal, Antibodies, Monoclonal, Humanized, Antibodies, Neoplasm, Antineoplastic Agents, Antineoplastic Combined Chemotherapy Protocols, Bone Marrow Purging, Bone Marrow Transplantation, Cyclophosphamide, Female, Graft Survival, Graft vs Host Disease, Humans, Leukemia, Lymphocytic, Chronic, B-Cell, Lymphocyte Depletion, Lymphoma, Male, Middle Aged, Survival Analysis, Transplantation Conditioning, Treatment Outcome, Vidarabine