Alemtuzumab (MabCampath)

• About alemtuzumab
• Common side effects
• Occasional side effects
• Rare side effects
• Important points to remember
• Immunisations and alemtuzumab

Alemtuzumab (pronounced al-em-too-zoo-mab) is a type of monoclonal antibody. Monoclonal antibodies are a type of biological therapy. Alemtuzumab is also called Campath or Mabcampath. It is a treatment for chronic lymphocytic leukaemia (CLL). You may also have it as part of a clinical trial for CLL or lymphoma.

Alemtuzumab targets a protein called CD52. CD52 is found on the surface of mature B lymphocytes - a type of white blood cell. In CLL, it is the B lymphocytes that are abnormal. The alemtuzumab sticks to all the CD 52 proteins it finds on the leukaemic B cells. Then the immune system picks out the marked cells and kills them.

Early B cells don’t have the CD52 protein and so aren’t killed. This means they can then produce healthy B cells, so the number in the body is back to normal within a few months of treatment.

You usually have alemtuzumab through a drip into a vein (an infusion). Research is also looking at giving it as an injection under the skin (subcutaneously). You have the infusion over 2 hours. You start on a low dose and the doctor gradually increases the dose until you are having the recommended amount. This is called dose escalation. Doctors do this because some people react to the treatment. By gradually increasing the dose you are less likely to react. While you are having dose escalation you have treatment daily. It takes between 3 days and a week to reach the right dose. Then you have treatment 3 times a week, for between 4 and 12 weeks.

The side effects associated with alemtuzumab are listed below. The side effects may be different if you are having it with other drugs.

With this drug, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects

• Increased risk of getting an infection from a drop in white blood cells - it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, sore throat, pain passing urine or feel cold and shivery. 
• Tiredness and breathlessness due to a drop in red blood cells (anaemia) - you may need a blood transfusion
• Bruising more easily due to a drop in platelets - you may have nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia).

Some of these side effects can be life threatening, particularly infections.  You should contact your doctor if you have any of these side effects.  Your doctor will check your blood counts regularly to see how well your bone marrow is working

Other common side effects include

• A reaction to alemtuzumab in 4 out of 5 people (80%), usually in the first week of treatment, with flu like symptoms such as a fever, chills and shivering (rigors), a headache, feeling sick and itching. Your doctor will give you medicines beforehand to try to prevent a reaction, and if you do have one, your nurse will slow down or stop your drip for a while
• Feeling sick or being occasionally being sick, affects 1 out of 2 people (50%), but is usually well controlled with anti sickness drugs
• Diarrhoea, affects 1 in 5 people (20%)– drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Sore mouth and mouth ulcers
• Changes to your blood pressure - it may be raised or lowered
• Fatigue (tiredness) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Skin reaction, affects 1 in 5 people (20%), causing dryness and itching and reddening
• Sweating
• Breathlessness affects 1 in 4 people (25%). You may also have a cough. If you have difficulty breathing, tell your doctor
• Loss of fertility - we don’t know what effect this drug may have on your fertility. Talk to your doctor before starting treatment if this important to you
• This drug may have a harmful effect on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant

Some people may have one or more of these side effects

• Abdominal pain and pain in other parts of your body (muscles, bones, joints)
• Indigestion
• Constipation - your doctor may give you laxatives to help prevent this but do tell them if you are constipated for more than 3 days
• Watery, itchy eyes
• Loss of appetite
• Liver changes [LINK about-cancer/treatment/cancer-drugs/side-effects/your-kidneys-liver-heart-and-lungs-and-cancer-drugs#liver] that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment is finished, but you will have regular blood tests to check how well your liver is working

A very small number of people may have one or more of these side effects

• More severe allergic reaction, with wheezing, an itchy rash and a drop in blood pressure. Your doctor will give you medicines beforehand to try to prevent a reaction. If you have a reaction to the drug, your nurse will slow your drip down or stop it for a while
• Pneumonia
• Heart attack
• Kidney problems-you will have regular blood tests to check how well your kidneys are working
• Bleeding in your stomach - ulcer

The side effects above may be mild or more severe. A side effect may get better or worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

• How many times you've had the drug before
• Your general health
• The amount of the drug you have (the dose)
• Other drugs you are having

Some side effects are inconvenient or upsetting but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because

• Your side effect may need treating
• Your drug dose may need reducing to try to prevent the side effect

Talk to your doctor, pharmacist or nurse about all your side effects so that they can help you manage them. Your specialist, clinic or ward nurse should give you a contact number. You can ring if you have any questions or problems. They can give you advice or reassure you. If in doubt, call them.

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies - some drugs can react together.

You should not have immunisations with live vaccines while you are having treatment or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG and yellow fever. You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your treatment.

It is perfectly safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but no one in the UK is given an oral vaccine now. So there is no problem in being with any baby or child who has recently had any vaccination in the UK. If you live abroad, you might need to make sure that you aren't in contact with anyone who has had oral polio or oral typhoid vaccination recently.