An expert opinion roundtable held August 8-9, 2002, brought together clinicians with the most extensive experience with the use of
alemtuzumab to pool knowledge and develop treatment goals and guidelines for optimal
therapy. By sharing our collective experience, we have been able to formulate recommendations for current clinical practice, which are included in this report, and have emphasized results that have implications for future practice. Guidelines for the management of acute "first-dose" events, prophylaxis for
infection, detection and treatment of cytomegalovirus reactivation, and hematologic support are presented, with emphasis on allowing patients to proceed smoothly through
therapy while maximizing therapeutic benefit. Management of adverse events is facilitated by the predictable timing of their appearance. In general, hematologic adverse events are transient, manageable, and reversible. Clinicians should be cautious of prematurely terminating treatment at 4-6 weeks in patients whose disease responds to treatment. Although resolution of peripheral blood
lymphocytosis occurs early in most patients, bone marrow is unlikely to be clear of disease. In particular, grade 4
neutropenia at this time is common and, because it is manageable, it is not an indication to discontinue treatment. The eradication of
minimal residual disease from blood and bone marrow observed with
alemtuzumab therapy is a major step forward in the treatment of
B-cell chronic lymphocytic leukemia. Combination
therapies such as
alemtuzumab/
fludarabine with the potential to maximize eradication at all disease sites should be systematically investigated. Because high response rates and few complications are observed in previously untreated patients, the use of
alemtuzumab earlier in
therapy may provide optimum benefit to patients.