Alemtuzumab is a cancer treatment that is mainly used to treat chronic lymphocytic leukaemia (CLL). Sometimes it's used to treat other types of cancer as part of a research trial. It may also be used as part of a stem cell transplant to help prevent some of the side effects.
This page describes alemtuzumab, how it's given and some of its possible side effects. It should ideally be read with our general information about CLL or your type of cancer.
Alemtuzumab belongs to a group of cancer drugs known as monoclonal antibodies. Monoclonal antibodies are sometimes called targeted therapies, because they work by ‘targeting’ specific proteins (receptors) on the surface of cells.
Alemtuzumab is also known as Campath or MabCampath.
Alemtuzumab locks on to a protein called CD52, which is found on the surface of white blood cells called B-lymphocytes and T-lymphocytes (B-cells and T-cells). This triggers the body’s immune system to attack the cells and destroy them.
When alemtuzumab is used
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Alemtuzumab is mainly used to treat CLL, a type of blood cancer in which large amounts of abnormal B-lymphocytes are made. Alemtuzumab is licensed as a treatment for people with CLL who can't have treatment with fludarabine in combination with other chemotherapy drugs.
Alemtuzumab may also be used as part of a research trial to treat other types of leukaemia or lymphoma, or as part of a stem cell transplant.
What alemtuzumab looks like
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After being diluted, alemtuzumab is a colourless fluid.
How alemtuzumab is given
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Alemtuzumab is given into a vein as a drip (intravenous infusion) over about two hours. Less commonly, it can be given as an injection under the skin (subcutaneously). Most people have treatment with alemtuzumab for 4–12 weeks.
Alemtuzumab may cause an allergic reaction, especially in the first week of treatment, so you'll be given medicines before the infusion to reduce the risk of a reaction. If you do have a reaction, the infusion can be stopped and restarted once you feel better.
To reduce the risk of a reaction, you'll be given a low dose of alemtuzumab for your first infusion. The dose will then be increased each day until the recommended dose is achieved. This usually takes 3–7 days and is known as dose escalation.
You may need to stay in hospital overnight while you're having dose escalation. Once you are on the recommended dose of alemtuzumab, you will have treatment three times a week (for example on Monday, Wednesday and Friday) as an outpatient. You may be asked to stay in hospital for a few hours after each infusion so that you can be monitored for signs of a reaction.
Possible side effects of alemtuzumab
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Each person’s reaction to cancer treatment is different. Some people have very few side effects, while others may experience more. The side effects described here won't affect everyone who has this treatment.
We've outlined the most common side effects, but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed here, discuss them with your doctor or specialist nurse.
Most side effects of alemtuzumab fall into two groups:
Side effects that may occur during the infusion or for up to about 24 hours afterwards (called infusion-related reactions).
Side effects that may occur days or weeks later – the main one is an increased risk of infection.
These are common, especially during the first week of treatment. Reactions are usually mild or moderate, but sometimes they can be more severe. If you have a reaction, it can usually be treated by stopping the drip until you feel better.
Alemtuzumab can cause a fall in blood pressure in some people, so your blood pressure will be checked regularly during the infusion. If you normally take medicines to lower your blood pressure, discuss this with your doctor.
You’ll be monitored closely during your infusion, but it's very important to tell your nurse or doctor if you feel unwell or have any of the following symptoms:
flu-like symptoms, such as feeling flushed, shivery, dizzy or having a fever
feeling sick (nausea) or being sick (vomiting)
a rash made up of red, warm and itchy bumps on the skin (like nettle rash)
a feeling of swelling in your lips, tongue or throat
breathlessness, wheezing, a cough or sudden difficulty in breathing
pain in your back or stomach
a tight chest or chest pain.
Sometimes a reaction may occur a few hours after treatment. If you develop these symptoms or feel unwell after you get home, contact the hospital straight away for advice.
Other possible side effects
Risk of infection
Alemtuzumab reduces the number of lymphocytes in your blood. It may also reduce the number of neutrophils. Lymphocytes and neutrophils are types of white blood cells.
White blood cells help fight infection. If the number of your white blood cells is low, you will be more prone to infections. A low white blood cell count is called neutropenia.
To help prevent infections, you'll be given antibiotics and antivirals (drugs that fight viruses) to take during your treatment and for at least two months afterwards. You will have regular blood tests to check your number of white blood cells.
Contact your doctor or the hospital straight away if:
your temperature goes above 38˚C (100.4˚F)
you suddenly feel unwell, even if your temperature is normal.
Increased bruising or bleeding
Alemtuzumab can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots, or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
Alemtuzumab can cause diarrhoea. This can usually be easily controlled with medicine, but tell your doctor if it is severe or continues. It's important to drink plenty of fluids if you have diarrhoea.
You may get constipated. This can usually be helped by drinking plenty of fluids, eating more fibre in your diet, and doing some gentle exercise, such as walking. You may need to take medicine (laxatives) to help. Your doctor can prescribe these or you can buy them from a pharmacy.
Loss of appetite
Some people lose their appetite while they’re having alemtuzumab. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Pain in the joints or muscles
This may be caused by alemtuzumab. It's important to tell your doctor about this, as they can prescribe painkillers.
Breathlessness or a cough
Let your doctor or nurse know if you develop a cough or have any breathlessness.
Alemtuzumab may affect the way your heart works. For this reason, it will be used with caution if you have a history of heart problems. Tests to see how well your heart is working may sometimes be carried out.
It's important to let your doctor know straight away if you feel unwell or have any severe side effects, even it they're not mentioned above.
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In some people, a virus called cytomegalovirus (CMV), which is already in their body, may become active during treatment with Campath. This may cause symptoms.
CMV is a common virus that many people have been exposed to at some point in their lives. Usually CMV infection causes no symptoms, or very few, so most people don't know they've had it. Once the virus is in your system, it stays in your body for life. But it's normally inactive (dormant) and doesn't cause any problems.
To detect if CMV is becoming active during treatment, you'll have regular tests to check the level of CMV in your blood. If these tests show that CMV is becoming active, it will be treated with antiviral medicines.
Some medicines, including those that you can buy from a shop or pharmacy, can be harmful to take when you are having cancer treatment. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
It's not advisable to become pregnant or father a child while having alemtuzumab, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether biological therapies can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after treatment.
It's not known what effects alemtuzumab may have on your ability to have children in the future. If you have concerns about this, it's important to discuss them with your doctor before beginning treatment.
You should avoid having live vaccines during treatment and for at least 12 months afterwards. Live vaccines include BCG, yellow fever, measles, mumps, rubella, liquid typhoid, poliomyelitis liquid and MMR.
Blood and platelet transfusions
If you need a blood or platelet transfusion during or after treatment with alemtuzumab, you'll be given blood or platelets that have been treated with radiation (irradiated). This is to stop any white blood cells that may be in the transfusion from causing you problems. Irradiating blood products doesn’t make them radioactive.
You will be given a card to carry to remind the hospital staff that you should only be given irradiated blood products, and it will be recorded in your hospital notes.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having treatment with alemtuzumab. You should tell them the name of your cancer specialist so they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This information has been compiled using information from a number of reliable sources, including:
electronic Medicines Compendium (eMC). http://www.emc.medicines.org.uk (accessed September 2012).
The European Medicines Agency. Product information: MabCampath. http://www.ema.europa.eu (accessed September 2012).
Scottish Medicines Consortium. 494/08 - Alemtuzumab (MabCampath). September 2008.
Thank you to Professor Gareth Morgan, Professor of Haematology; and all the people affected by cancer who reviewed this edition. Reviewing information is just one of the ways you could help when you join our Cancer Voices network.