Alemtuzumab (MabCampath®)

What is MabCampath? Back to top

MabCampath is one of a new group of cancer drugs known as monoclonal antibodies. It is mainly used to treat people with B-cell chronic lymphocytic leukaemia (CLL) . It is sometimes used as part of research trials| to treat other types of leukaemia. MabCampath is usually given to people whose CLL has come back after previous treatment, or is not responding to chemotherapy| .

Monoclonal antibodies Back to top

Monoclonal antibodies|  are used to destroy some types of cancer cells, while causing little harm to normal cells. They recognise certain proteins found on the surface of some types of cancer cells. Once the monoclonal antibody recognises the protein it 'locks' onto it (like a key in a lock). This may then trigger the body’s immune system to attack the cancer cells and cause the cells to destroy themselves.

MabCampath locks on to a protein called CD52. This is found on the surface of certain white blood cells (lymphocytes), including those affected by the leukaemia. The leukaemic lymphocytes are known as malignant lymphocytes. MabCampath attacks both malignant and normal lymphocytes. The body quickly replaces any normal white blood cells that are damaged however, so the risk of side effects from the treatment is small.

What it looks like Back to top

MabCampath is a colourless fluid after being diluted.

How is it given Back to top

MabCampath is given as a drip (infusion) through a fine tube (cannula) inserted into a vein in the arm or back of the hand. Each drip takes approximately two hours. It can also be given as an injection under the skin (subcutaneously).

Some people have an allergic reaction to MabCampath (see early side effects| ). To reduce the risk of a reaction the first few doses are given slowly. You may also be given some antihistamines, paracetamol and sometimes a small dose of steroids before the infusion. These will help to reduce the risk of reactions. If you do have a reaction, the infusion can be stopped and started again once the symptoms are over.

You will be asked to stay in hospital for a few hours after the infusion, or possibly overnight, to be monitored. The dose of MabCampath is increased over a few days until the recommended dose is achieved. This usually takes 3–7 days and is known as dose escalation. Once the recommended dose is achieved, the treatment is given three times a week (for example on Monday, Wednesday and Friday). Most people have treatment for 4–12 weeks.

Possible side effects Back to top

Each person’s reaction to a cancer drug is different. Some people have very few side effects, while others may experience more. We have outlined the most common side effects, so that you can be aware of them if they occur.

However, we have not included those which are very rare and therefore extremely unlikely to affect you. If you notice any effects that you think may be due to the drug, but which are not listed below, please discuss them with your doctor or nurse.

Most side effects of MabCampath fall into two groups:

• early side effects – those which occur during or immediately after the drug has been given (which include allergic-type reactions)
• later side effects – those which occur after a few weeks of treatment, of which the main one is an increased risk of infection.

Early side effects Back to top

• Allergic reactions It's common to have a slight allergic reaction to MabCampath, but some people have a more severe reaction. Signs of a reaction include skin rashes and itching, a feeling of swelling in the tongue or throat, irritation of the nasal passages, wheezing, a cough and breathlessness . You will be monitored closely during your treatment but it is very important to tell your nurse or doctor if you have any of these symptoms.
  To reduce the chance of developing an allergic reaction, certain drugs (antihistamines and/or steroids) may be given before the infusion. The infusion can also be slowed down or stopped until the reaction is over. Once the treatment has ended, the reaction generally gets better within a few hours. It's almost always more severe with the first few doses.
• Flu-like symptoms  This can include a high temperature and chills, weakness, sweating, muscle aches, tiredness , dizziness and headaches. These effects may occur while the drug is being given, but don't usually last long.
• Feeling sick (nausea ) and occasionally being sick (vomiting)  Your doctor can prescribe anti-sickness (anti-emetic) drugs to prevent or reduce these effects. If the sickness isn't controlled, or if it continues, let your doctor know so that they can prescribe other anti-sickness drugs which may be more effective
• Low blood pressure  This may happen during the infusion, so your blood pressure will be checked regularly. If you normally take medicines to lower your blood pressure, discuss with your doctor whether you should change the medicines you take during this time.

Later side effects Back to top

After a few weeks of treatment, the effects listed below might occur.

• Lowered resistance to infection MabCampath can reduce the production of white blood cells by the bone marrow, making you more prone to bacterial and viral infection . This risk is usually at its highest while you are having the treatment and for about two months afterwards. It is recommended that antibiotic and antiviral medication is taken during MabCampath treatment and for at least two months afterwards. For some people, the production of white blood cells by the bone marrow may be reduced for up to a year after treatment and they may need to take antibiotic medication for longer.
• Problems with blood clotting This is caused by a reduction in the production of platelets by the bone marrow. It may lead to an increased risk of bleeding, although this usually only lasts a short time. You will have your blood checked regularly to monitor this.
• Diarrhoea This can usually be controlled with anti-diarrhoea medicine, but let your doctor know if it is severe or if it continues. It's important to drink plenty of fluids.

Less common side effects Back to top

• Constipation This can usually be managed by eating a high fibre diet and drinking plenty of fluids. You may also need simple laxatives. Let your doctor know if you become constipated .
• Rashes and increased sweating MabCampath can cause a rash which may be itchy, and increased sweating. Tell your nurse or doctor if you have these side effects.
• Pain in the joints or muscles It is important to tell your doctor about this, so that appropriate painkillers can be prescribed.
• Breathlessness or a cough Let your doctor or nurse know if you develop a cough or have any breathlessness .
• Cytomegalovirus (CMV) CMV is a common virus that many people have been exposed to at some point in their lives. It can remain dormant (not cause any symptoms) in your blood system. CMV can become active (cause symptoms) while you are on MabCampath. You will have regular tests to check for CMV levels while you are on this treatment.

Additional information Back to top

MabCampath may worsen heart problems in people who already have them. For this reason it will be used with caution if you have had heart disease.

It is unknown what effect MabCampath may have on an unborn baby. It is recommended that women able to become pregnant, and men who are sexually active, use effective birth control while having MabCampath and for at least one year after the treatment has ended. It is recommended that women should not breastfeed during the treatment and for at least four weeks afterwards.

People having treatment with MabCampath should avoid having live vaccines, such as liquid typhoid, BCG, yellow fever, measles, mumps, rubella, poliomyelitis liquid and MMR.

References Back to top

This section has been compiled using information from a number of reliable sources including:

• Sweetman et al. Martindale: The Complete Drug Reference. 36th edition. 2009. Pharmaceutical Press.

• British National Formulary. 58th edition. 2009. British Medical Association and Royal Pharmaceutical Society of Great Britain. 

For further references, please see the general bibliography| .