update 21 februari 2010:

Een nieuwe studie toont aan dat Campath (Alemtuzumab) naast andere chemo een goed effect heeft bij bepaalde vormen van leukemie (PTCL) maar dat dit middel niet veilig is. Er stierven teveel mensen gerelateerd aan de toediening van Campath naast andere chemo's bij PTCL . De onderzoekers stellen dan ook dat Campath niet verder onderzocht zou moeten worden gezien het gebrek aan veiligheid. Onder nieuwste abstract staat nog een veelbelovende studie maar die lijkt dus hiermee achterhaald? Al lijkt Campath alleen na beenmergtransplantatie nog steeds wel onderwerp van onderzoek.

Leuk Lymphoma. 2010 Mar;51(3):447-55.

A phase II study of alemtuzumab, fludarabine, cyclophosphamide, and doxorubicin (Campath-FCD) in peripheral T-cell lymphomas.

Weidmann E, Hess G, Chow KU, Krause SW, Subklewe M, Kruse J, Weisel KC, Soekler M, Kim SZ, Napieralski S, Rech J, Dreyling M, Jäger E, Mitrou PS.

Klinik für Onkologie und Hämatologie, Krankenhaus Nordwest, Frankfurt am Main, Germany.

The clinical course of peripheral T-cell lymphoma (PTCL) is usually aggressive and the prognosis unfavorable. Therefore, there is a need for improvement of treatment options. Patients with newly diagnosed (n = 27) or refractory/relapsed (n = 11) PTCL received a combination of alemtuzumab, fludarabine, cyclophosphamide, and doxorubicin. The overall response rate (ORR) was 61%, with a complete response rate of 39%. In newly diagnosed patients the ORR was 63%, the median overall survival 25.9 months, and progression-free survival 11.8 months. In relapsed/refractory patients the median OS was 6.1 months. The most frequent grade 3/4 toxicities were leukopenia (95% of patients) and thrombocytopenia (58%). Cytomegalovirus (CMV) reactivation occurred in 12 patients, but only two had CMV disease. Treatment-related deaths occurred in six newly diagnosed patients and one with relapsed/refractory disease. In conclusion, Campath-FCD is active in PTCL but is associated with significant toxicity and is, therefore, not recommended for use or further study. Further studies are warranted to investigate other approaches to combining alemtuzumab with chemotherapy for the treatment of PTCL.

PMID: 20141439 [PubMed - in process]

Van de ouders van Robin en Shifra had ik al eens gehoord van dit middel, Campath, een monoklonaal middel dat gebruikt wordt bij leukemie. Monoklonale antilichamen zijn stoffen die zich als antilichaam (je zou kunnen spreken van een soort vaccinatie) richten op één specifieke cellijn, welke slechts één immunoglobuline vormt (als ik het zo goed uitleg tenminste). Simpeler: een medicament, dat zeer gericht werkt tegen deze specifieke kankersoort. Onderstaand een artikel dat ik tegenkwam op internet, nadat een bezoeker mij informatie vroeg omdat zijn behandelend arts dit aan hem had voorgesteld. Vooralsnog dit artikel en studiebeschrijving uit Engeland.

CLINICAL TRANSLATIONAL PROGRAMME

Team leaders: Professor D Catovsky DSc(Med) FRCPath FRCP FMedSci, Dr E Matutes MD PhD FRCPath

High Remission Rate in T-prolymphocytic Leukaemia with Campath-1H

CE Dearden, E Matutes, MJS Dyer, CE Rudin, D Catovsky; in collaboration with B Cazin, Lille, France; GE Tjønnfjord, Oslo, Norway; A Parreira, Lisbon, Portugal; RL Powles, S Kulkarni, Leukaemia Unit
Source of funding: The Royal Marsden Trust Funds, ILEX, Edinburgh

T-prolymphocytic leukaemia (T-PLL) is an aggressive T-cell malignancy with a median survival of 7.5 months. We have treated T-PLL patients in an international collaborative study with a reshaped humanised monoclonal antibody Campath-1H that detects the CD52 antigen in B- and T-lymphocytes. All patients had progressive disease and most had received prior therapy. The overall response rate was 76% with 60% complete remissions (CR). Survival was significantly prolonged in patients who achieved CR compared to partial and non-responders. The immunophenotype or the cytogenetic changes did not influence response. Toxicity included the cytokine release syndrome in most patients, haematological toxicity in 12% and infections in 20%. In ten patients responses to Campath-1H were consolidated with high dose therapy followed by autologous or allogeneic stem-cell transplantation. Stem-cell harvests were uncontaminated with leukaemic cells as demonstrated by flow cytometry and PCR analysis of T-cell receptor genes. These data demonstrate that Campath-1H is the most effective therapy in T-PLL, a disease with poor outcome, and should be promoted as first line therapy. The use of high dose therapy with stem-cell transplant to consolidate the responses obtained with Campath-1H merits further study.

leukemie, campath