Alemtuzumab in CLL and other lymphoid neoplasms

The recent success of monoclonal antibodies in the treatment of various hematological and nonhematological cancers is the result of several decades of research in immune therapy of cancer. The identification of cancer-specific surface markers has led to the development of numerous monoclonal antibodies directed at these antigens, which have been associated with variable success in treating patients with different malignancies. Alemtuzumab, one such monoclonal antibody, is a humanized antibody directed against CD52. The target antigen is a small glycosylphosphatidylinositol (GPI)-anchored glycoprotein that is highly expressed on normal T- and B-lymphocytes and on a large proportion of malignant lymphoid cells, but not on hematopoietic progenitor cells. A number of clinical trials have demonstrated the clinical activity of alemtuzumab in chronic lymphocytic leukemia (CLL), T-cell malignancies such as T-prolymphocytic leukemia (T-PLL) and cutaneous T-cell lymphoma (CTCL), and have examined its role as an immunosuppressive agent in transplantation and for the treatment of autoimmune disorders. Effective antibiotic prophylaxis can limit the incidence of infections, which are the major side effect associated with the profound lymphopenia occurring as a result of treatment with this agent.