Skip to main content

Advertisement

SpringerLink
Log in

Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Infection is a significant cause of morbidity and death in patients with chronic lymphocytic leukemia (CLL). Increased infectious events may arise from the multiple courses of immunosuppressive therapy and progressive deterioration of a patient’s immune system over the course of disease. The humanized, anti-CD52 monoclonal antibody alemtuzumab (Campath or Campath-1H) has shown notable activity for both untreated and fludarabine-refractory CLL. The antibody not only targets malignant cells but also affects normal, healthy immune cells. The cumulative effects of the malignancy and successive courses of treatments adversely impinge on a patient’s defense response to certain bacterial, fungal, and viral infections. In this review article, we provide an overview of common infectious events associated with alemtuzumab therapy in CLL. We also discuss recommendations for effectively monitoring and managing infections in CLL patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Akova M, Paesmans M, Calandra T, Viscoli C (2005) A European organization for research and treatment of cancer—International Antimicrobial Therapy Group Study of secondary infections in febrile, neutropenic patients with cancer. Clin Infect Dis 40:239–245

    Article  PubMed  Google Scholar 

  2. Beyer M, Kochanek M, Darabi K, Popov A, Jensen M, Endl E, Knolle PA, Thomas RK, von Bergwelt-Baildon M, Debey S, Hallek M, Schultze JL (2005) Reduced frequencies and suppressive function of CD4+ CD25hi regulatory T cells in patients with chronic lymphocytic leukemia after therapy with fludarabine. Blood 106:2018–2025

    Article  PubMed  CAS  Google Scholar 

  3. Briggs PG, Kraft N, Atkins RC (1990) T cells and CD45R expression in B-chronic lymphocytic leukemia. Leuk Res 14:155–159

    Article  PubMed  CAS  Google Scholar 

  4. Caillot D, Couaillier JF, Bernard A, Casasnovas O, Denning DW, Mannone L, Lopez J, Couillault G, Piard F, Vagner O, Guy H (2001) Increasing volume and changing characteristics of invasive pulmonary aspergillosis on sequential thoracic computed tomography scans in patients with neutropenia. J Clin Oncol 19:253–259

    PubMed  CAS  Google Scholar 

  5. Chakrabarti S, MacDonald D, Hale G, Holder K, Turner V, Czarnecka H, Thompson J, Fegan C, Waldmann H, Milligan DW (2003) T-cell depletion with Campath-1H “in the bag” for matched related allogeneic peripheral blood stem cell transplantation is associated with reduced graft-versus-host disease, rapid immune constitution and improved survival. Br J Haematol 121:109–118

    Article  PubMed  Google Scholar 

  6. Chakraverty R, Peggs K, Chopra R, Milligan DW, Kottaridis PD, Verfuerth S, Geary J, Thuraisundaram D, Branson K, Chakrabarti S, Mahendra P, Craddock C, Parker A, Hunter A, Hale G, Waldmann H, Williams CD, Yong K, Linch DC, Goldstone AH, Mackinnon S (2002) Limiting transplantation-related mortality following unrelated donor stem cell transplantation by using a nonmyeloablative conditioning regimen. Blood 99:1071–1078

    Article  PubMed  CAS  Google Scholar 

  7. Cornely OA, Bohme A, Buchheidt D, Glasmacher A, Kahl C, Karthaus M, Kern W, Kruger W, Maschmeyer G, Ritter J, Salwender HJ, Sandherr M, Schiel X, Schuttrumpf S, Sieniawski M, Silling G, Ullmann AJ, Wolf HH (2003) Prophylaxis of invasive fungal infections in patients with hematological malignancies and solid tumors—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Ann Hematol 82(Suppl 2):S186–S200

    Article  PubMed  Google Scholar 

  8. Cornely OA, Maertens J, Bresnik M, Ebrahimi R, Ullmann AJ, Bouza E, Heussel CP, Lortholary O, Rieger C, Boehme A, Aoun M, Horst HA, Thiebaut A, Ruhnke M, Reichert D, Vianelli N, Krause SW, Olavarria E, Herbrecht R (2007) Liposomal amphotericin B as initial therapy for invasive mold infection: a randomized trial comparing a high-loading dose regimen with standard dosing (AmBiLoad trial). Clin Infect Dis 44:1289–1297

    Article  PubMed  CAS  Google Scholar 

  9. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, -Gonzalez D (2007) Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med 356:348–359

    Article  PubMed  CAS  Google Scholar 

  10. Delgado J, Thomson K, Russell N, Ewing J, Stewart W, Cook G, Devereux S, Lovell R, Chopra R, Marks DI, Mackinnon S, Milligan DW (2006) Results of alemtuzumab-based reduced-intensity allogeneic transplantation for chronic lymphocytic leukemia: a British Society of Blood and Marrow Transplantation Study. Blood 107:1724–1730

    Article  PubMed  CAS  Google Scholar 

  11. Eichhorst BF, Busch R, Schweighofer C, Wendtner CM, Emmerich B, Hallek M (2007) Due to low infection rates no routine anti-infective prophylaxis is required in younger patients with chronic lymphocytic leukaemia during fludarabine-based first line therapy. Br J Haematol 136(1):63–72

    Article  PubMed  CAS  Google Scholar 

  12. Elter T, Borchmann P, Schulz H, Reiser M, Trelle S, Schnell R, Jensen M, Staib P, Schinkothe T, Stutzer H, Rech J, Gramatzki M, Aulitzky W, Hasan I, Josting A, Hallek M, Engert A (2005) Fludarabine in combination with alemtuzumab is effective and feasible in patients with relapsed or refractory B-cell chronic lymphocytic leukemia: results of a phase II trial. J Clin Oncol 23:7024–7031

    Article  PubMed  CAS  Google Scholar 

  13. Ferrajoli A, O’Brien SM, Cortes JE, Giles FJ, Thomas DA, Faderl S, Kurzrock R, Lerner S, Kontoyiannis DP, Keating MJ (2003) Phase II study of alemtuzumab in chronic lymphoproliferative disorders. Cancer 98:773–778

    Article  PubMed  CAS  Google Scholar 

  14. Fischer K, Schweighofer CD, Ritgen M, Bottcher S, Scharf E, Eichhorst BF, Busch R, Abenhardt W, Kneba M, Hallek M, Wendtner CM, the German CLL Study Group (2007) Dose-escalation study to evaluate dose limiting toxicity (DLT), maximum tolerated dose (MTD) and safety of alemtuzumab for consolidation therapy in patients with chronic lymphocytic leukemia: phase I/II trial of the German CLL Study Group (GCLLSG) [abstract 2053]. Blood 110:612a

    Google Scholar 

  15. Francis S, Karanth M, Pratt G, Starczynski J, Hooper L, Fegan C, Pepper C, Valcarcel D, Milligan DW, Delgado J (2006) The effect of immunoglobulin VH gene mutation status and other prognostic factors on the incidence of major infections in patients with chronic lymphocytic leukemia. Cancer 107:1023–1033

    Article  PubMed  CAS  Google Scholar 

  16. Gamadia LE, Rentenaar RJ, Baars PA, Remmerswaal EB, Surachno S, Weel JF, Toebes M, Schumacher TN, IJ ten Berge, Van Lier RA (2001) Differentiation of cytomegalovirus-specific CD8(+) T cells in healthy and immunosuppressed virus carriers. Blood 98:754–761

    Article  PubMed  CAS  Google Scholar 

  17. Gilleece MH, Dexter TM (1993) Effect of Campath-1H antibody on human hematopoietic progenitors in vitro. Blood 82:807–812

    PubMed  CAS  Google Scholar 

  18. Gorgun G, Holderried TA, Zahrieh D, Neuberg D, Gribben JG (2005) Chronic lymphocytic leukemia cells induce changes in gene expression of CD4 and CD8 T cells. J Clin Invest 115:1797–1805

    Article  PubMed  CAS  Google Scholar 

  19. Hale G, Bright S, Chumbley G, Hoang T, Metcalf D, Munro AJ, Waldmann H (1983) Removal of T cells from bone marrow for transplantation: a monoclonal antilymphocyte antibody that fixes human complement. Blood 62:873–882

    PubMed  CAS  Google Scholar 

  20. Hale G, Cobbold S, Waldmann H (1988) T cell depletion with CAMPATH-1 in allogeneic bone marrow transplantation. Transplantation 45:753–759

    Article  PubMed  CAS  Google Scholar 

  21. Hensel M, Kornacker M, Yammeni S, Egerer G, Ho AD (2003) Disease activity and pretreatment, rather than hypogammaglobulinaemia, are major risk factors for infectious complications in patients with chronic lymphocytic leukaemia. Br J Haematol 122:600–606

    Article  PubMed  Google Scholar 

  22. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, Kern WV, Marr KA, Ribaud P, Lortholary O, Sylvester R, Rubin RH, Wingard JR, Stark P, Durand C, Caillot D, Thiel E, Chandrasekar PH, Hodges MR, Schlamm HT, Troke PF, de PB (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415

    Article  PubMed  CAS  Google Scholar 

  23. Heussel CP, Kauczor HU, Heussel GE, Fischer B, Begrich M, Mildenberger P, Thelen M (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17:796–805

    PubMed  CAS  Google Scholar 

  24. Hillmen P, Skotnicki AB, Robak T, Jaksic B, Dmoszynska A, Wu J, Sirard C, Mayer J (2007) Alemtuzumab compared with chlorambucil as first-line therapy for chronic lymphocytic leukemia. J Clin Oncol 25:5616–5623

    Article  PubMed  CAS  Google Scholar 

  25. Hooper M, Kallas EG, Coffin D, Campbell D, Evans TG, Looney RJ (1999) Cytomegalovirus seropositivity is associated with the expansion of CD4+. J Rheumatol 26:1452–1457

    PubMed  CAS  Google Scholar 

  26. Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, Feld R, Pizzo PA, Rolston KV, Shenep JL, Young LS (2002) 2002 Guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis 34:730–751

    Article  PubMed  Google Scholar 

  27. Itala M, Helenius H, Nikoskelainen J, Remes K (1992) Infections and serum IgG levels in patients with chronic lymphocytic leukemia. Eur J Haematol 48:266–270

    Article  PubMed  CAS  Google Scholar 

  28. Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ (2007) Cancer statistics, 2007. CA Cancer J Clin 57:43–66

    PubMed  Google Scholar 

  29. Keating M, Coutre S, Rai K, Osterborg A, Faderl S, Kennedy B, Kipps T, Bodey G, Byrd JC, Rosen S, Dearden C, Dyer MJ, Hillmen P (2004) Management guidelines for use of alemtuzumab in B-cell chronic lymphocytic leukemia. Clin Lymphoma 4:220–227

    Article  PubMed  CAS  Google Scholar 

  30. Keating MJ, Flinn I, Jain V, Binet JL, Hillmen P, Byrd J, Albitar M, Brettman L, Santabarbara P, Wacker B, Rai KR (2002) Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood 99:3554–3561

    Article  PubMed  CAS  Google Scholar 

  31. Kruger WH, Bohlius J, Cornely OA, Einsele H, Hebart H, Massenkeil G, Schuttrumpf S, Silling G, Ullmann AJ, Waldschmidt DT, Wolf HH (2005) Antimicrobial prophylaxis in allogeneic bone marrow transplantation. Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Haematology and Oncology. Ann Oncol 16:1381–1390

    Article  PubMed  CAS  Google Scholar 

  32. Lin TS, Donohue KA, Lucas MS et al (2007) Consolidation therapy with subcutaneous (SC) alemtuzumab results in severe infectious toxicity in previously untreated CLL patients who achieve a complete response (CR) after fludarabine and rituximab (FR) induction therapy: interim safety analysis of the CALGB Study 10101 [abstract 755]. Blood 110:232a

    Google Scholar 

  33. Lundin J, Kimby E, Bjorkholm M, Broliden PA, Celsing F, Hjalmar V, Mollgard L, Rebello P, Hale G, Waldmann H, Mellstedt H, Osterborg A (2002) Phase II trial of subcutaneous anti-CD52 monoclonal antibody alemtuzumab (Campath-1H) as first-line treatment for patients with B-cell chronic lymphocytic leukemia (B-CLL). Blood 100:768–773

    Article  PubMed  CAS  Google Scholar 

  34. Lundin J, Porwit-MacDonald A, Rossmann ED, Karlsson C, Edman P, Rezvany MR, Kimby E, Osterborg A, Mellstedt H (2004) Cellular immune reconstitution after subcutaneous alemtuzumab (anti-CD52 monoclonal antibody, CAMPATH-1H) treatment as first-line therapy for B-cell chronic lymphocytic leukaemia. Leukemia 18:484–490

    Article  PubMed  CAS  Google Scholar 

  35. Mackus WJ, Frakking FN, Grummels A, Gamadia LE, De Bree GJ, Hamann D, Van Lier RA, Van Oers MH (2003) Expansion of CMV-specific CD8+CD45RA+. Blood 102:1057–1063

    Article  PubMed  CAS  Google Scholar 

  36. Molteni A, Nosari A, Montillo M, Cafro A, Klersy C, Morra E (2005) Multiple lines of chemotherapy are the main risk factor for severe infections in patients with chronic lymphocytic leukemia with febrile episodes. Haematologica 90:1145–1147

    PubMed  Google Scholar 

  37. Montillo M, Tedeschi A, Miqueleiz S, Veronese S, Cairoli R, Intropido L, Ricci F, Colosimo A, Scarpati B, Montagna M, Nichelatti M, Regazzi M, Morra E (2006) Alemtuzumab as consolidation after a response to fludarabine is effective in purging residual disease in patients with chronic lymphocytic leukemia. J Clin Oncol 24:2337–2342

    Article  PubMed  CAS  Google Scholar 

  38. Moreton P, Kennedy B, Lucas G, Leach M, Rassam SM, Haynes A, Tighe J, Oscier D, Fegan C, Rawstron A, Hillmen P (2005) Eradication of minimal residual disease in B-cell chronic lymphocytic leukemia after alemtuzumab therapy is associated with prolonged survival. J Clin Oncol 23:2971–2979

    Article  PubMed  CAS  Google Scholar 

  39. Nabhan C, Gartenhaus RB, Tallman MS (2004) Purine nucleoside analogues and combination therapies in B-cell chronic lymphocytic leukemia: dawn of a new era. Leuk Res 28:429–442

    Article  PubMed  CAS  Google Scholar 

  40. Nguyen DD, Cao TM, Dugan K, Starcher SA, Fechter RL, Coutre SE (2002) Cytomegalovirus viremia during Campath-1H therapy for relapsed and refractory chronic lymphocytic leukemia and prolymphocytic leukemia. Clin Lymphoma 3:105–110

    Article  PubMed  CAS  Google Scholar 

  41. Nuckel H, Frey UH, Roth A, Duhrsen U, Siffert W (2005) Alemtuzumab induces enhanced apoptosis in vitro in B-cells from patients with chronic lymphocytic leukemia by antibody-dependent cellular cytotoxicity. Eur J Pharmacol 514:217–224

    PubMed  Google Scholar 

  42. O’Brien SM, Kantarjian HM, Thomas DA, Cortes J, Giles FJ, Wierda WG, Koller CA, Ferrajoli A, Browning M, Lerner S, Albitar M, Keating MJ (2003) Alemtuzumab as treatment for residual disease after chemotherapy in patients with chronic lymphocytic leukemia. Cancer 98:2657–2663

    Article  PubMed  CAS  Google Scholar 

  43. O’Brien SM, Keating MJ, Mocarski ES (2006) Updated guidelines on the management of cytomegalovirus reactivation in patients with chronic lymphocytic leukemia treated with alemtuzumab. Clin Lymphoma Myeloma 7:125–130

    Article  PubMed  CAS  Google Scholar 

  44. O’Brien S, Ravandi F, Riehl T, Wierda W, Huang X, Tarrand J, O’Neal B, Kantarjian H, Keating M (2008) Valganciclovir prevents CMV reactivation in patients receiving alemtuzumab based therapy. Blood 111(4):1816–1819

    Article  PubMed  CAS  Google Scholar 

  45. Oscier D, Fegan C, Hillmen P, Illidge T, Johnson S, Maguire P, Matutes E, Milligan D (2004) Guidelines on the diagnosis and management of chronic lymphocytic leukaemia. Br J Haematol 125:294–317

    Article  PubMed  CAS  Google Scholar 

  46. Osterborg A, Dyer MJ, Bunjes D, Pangalis GA, Bastion Y, Catovsky D, Mellstedt H (1997) Phase II multicenter study of human CD52 antibody in previously treated chronic lymphocytic leukemia. European Study Group of CAMPATH-1H Treatment in Chronic Lymphocytic Leukemia. J Clin Oncol 15:1567–1574

    PubMed  CAS  Google Scholar 

  47. Perkins JG, Flynn JM, Howard RS, Byrd JC (2002) Frequency and type of serious infections in fludarabine-refractory B-cell chronic lymphocytic leukemia and small lymphocytic lymphoma: implications for clinical trials in this patient population. Cancer 94:2033–2039

    Article  PubMed  Google Scholar 

  48. Pettitt AR, Matutes E, Oscier D (2006) Alemtuzumab in combination with high-dose methylprednisolone is a logical, feasible and highly active therapeutic regimen in chronic lymphocytic leukaemia patients with p53 defects. Leukemia 20:1441–1445

    Article  PubMed  CAS  Google Scholar 

  49. Rai KR, Freter CE, Mercier RJ, Cooper MR, Mitchell BS, Stadtmauer EA, Santabarbara P, Wacker B, Brettman L (2002) Alemtuzumab in previously treated chronic lymphocytic leukemia patients who also had received fludarabine. J Clin Oncol 20:3891–3897

    Article  PubMed  CAS  Google Scholar 

  50. Ravandi F, O’Brien S (2005) Alemtuzumab. Expert Rev Anticancer Ther 5:39–51

    Article  PubMed  CAS  Google Scholar 

  51. Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL (2004) The clinical and epidemiological burden of chronic lymphocytic leukaemia. Eur J Cancer Care (Engl) 13:279–287

    Article  CAS  Google Scholar 

  52. Robak T (2004) Monoclonal antibodies in the treatment of chronic lymphoid leukemias. Leuk Lymphoma 45:205–219

    Article  PubMed  CAS  Google Scholar 

  53. Sandherr M, Einsele H, Hebart H, Kahl C, Kern W, Kiehl M, Massenkeil G, Penack O, Schiel X, Schuettrumpf S, Ullmann AJ, Cornely OA (2006) Antiviral prophylaxis in patients with haematological malignancies and solid tumours: Guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society for Hematology and Oncology (DGHO). Ann Oncol 17:1051–1059

    Article  PubMed  CAS  Google Scholar 

  54. Schweighofer C, Ritgen M, Eichhorst B, Busch R, Kneba M, Hallek M, Wendtner C, the German CLL Study Group (2006) Consolidation with alemtuzumab improves progression-free survival in patients with chronic lymphocytic leukemia (CLL) in first remission: long-term follow-up of a randomized phase III trial of the German CLL study group (GCLLSG). Blood 108:33 Abstract

    Google Scholar 

  55. Stanglmaier M, Reis S, Hallek M (2004) Rituximab and alemtuzumab induce a nonclassic, caspase-independent apoptotic pathway in B-lymphoid cell lines and in chronic lymphocytic leukemia cells. Ann Hematol 83:634–645

    Article  PubMed  CAS  Google Scholar 

  56. Tsiodras S, Samonis G, Keating MJ, Kontoyiannis DP (2000) Infection and immunity in chronic lymphocytic leukemia. Mayo Clin Proc 75:1039–1054

    PubMed  CAS  Google Scholar 

  57. Ullmann AJ, Lipton JH, Vesole DH, Chandrasekar P, Langston A, Tarantolo SR, Greinix H, Morais de AW, Reddy V, Boparai N, Pedicone L, Patino H, Durrant S (2007) Posaconazole or fluconazole for prophylaxis in severe graft-versus-host disease. N Engl J Med 356:335–347

    Article  PubMed  CAS  Google Scholar 

  58. Waldmann H, Polliak A, Hale G, Or R, Cividalli G, Weiss L, Weshler Z, Samuel S, Manor D, Brautbar C (1984) Elimination of graft-versus-host disease by in-vitro depletion of alloreactive lymphocytes with a monoclonal rat anti-human lymphocyte antibody (CAMPATH-1). Lancet 2:483–486

    Article  PubMed  CAS  Google Scholar 

  59. Walsh TJ, Teppler H, Donowitz GR, Maertens JA, Baden LR, Dmoszynska A, Cornely OA, Bourque MR, Lupinacci RJ, Sable CA, dePauw BE (2004) Caspofungin versus liposomal amphotericin B for empirical antifungal therapy in patients with persistent fever and neutropenia. N Engl J Med 351:1391–1402

    Article  PubMed  CAS  Google Scholar 

  60. Warkentin DI, Epstein JB, Campbell LM, Yip JG, Cox VC, Ransier A, Barnett MJ, Marra F (2002) Valacyclovir versus acyclovir for HSV prophylaxisin neutropenic patients. Ann Pharmacother 36:1525–1531

    Article  PubMed  CAS  Google Scholar 

  61. Wendtner CM, Ritgen M, Schweighofer CD, Fingerle-Rowson G, Campe H, Jager G, Eichhorst B, Busch R, Diem H, Engert A, Stilgenbauer S, Dohner H, Kneba M, Emmerich B, Hallek M (2004) Consolidation with alemtuzumab in patients with chronic lymphocytic leukemia (CLL) in first remission-experience on safety and efficacy within a randomized multicenter phase III trial of the German CLL Study Group (GCLLSG). Leukemia 18:1093–1101

    Article  PubMed  CAS  Google Scholar 

  62. Wierda W, O’Brien S, Faderl S, Ferrajoli A, Wang X, Do KA, Garcia-Manero G, Thomas D, Cortes J, Ravandi-Kashani F, Giles F, Lerner S, Kantarjian H, Keating M (2006) A retrospective comparison of three sequential groups of patients with recurrent/refractory chronic lymphocytic leukemia treated with fludarabine-based regimens. Cancer 106:337–345

    Article  PubMed  CAS  Google Scholar 

  63. Zent CS, Chen JB, Kurten RC, Kaushal GP, Marie LH, Schichman SA (2004) Alemtuzumab (CAMPATH 1H) does not kill chronic lymphocytic leukemia cells in serum free medium. Leuk Res 28:495–507

    Article  PubMed  CAS  Google Scholar 

  64. Zenz T, Ritgen M, Dreger P, Krober A, Barth TF, Schlenk R, Bottcher S, Hallek MJ, Kneba M, Bunjes D, Dohner H, Stilgenbauer S (2006) Autologous graft-versus-host disease-like syndrome after an alemtuzumab-containing conditioning regimen and autologous stem cell transplantation for chronic lymphocytic leukemia. Blood 108:2127–2130

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This manuscript was supported in part by the German Competence Network on Malignant Lymphoma (KML) of the BMB-F. Editorial assistance for this manuscript was provided by Meniscus Health Care Communications, with the financial support of Schering AG. JG is a speaker for Roche, Genentech and Schering AG/Berlex. OAC is supported by the German Federal Ministry of Research and Education (BMBF grant 01KN0706); has received research grants from Astellas, Basilea, Bayer, Genzyme, Gilead, Pfizer, Merck, Schering-Plough, and Vicuron; is a consultant to Astellas, Basilea, F2G, Gilead, Pfizer, Merck, Mölnlycke, Nektar, Schering-Plough, and Zeneus; and served at the speakers’ bureau of Astellas, Gilead, Merck, Schering-Plough, SpePharm, and United Medical.

Disclosures

JJV received Travel grants from Astellas, Gilead, Merck, Pfizer, Schering-Plough, and Viropharma. TE, AE, MH received travel, speaker and research grants from BayerSchering.

Author information

Authors and Affiliations

  1. Department of Hematology, Oncology and Infectious Diseases, University of Cologne, Joseph-Stelzmann-Str.9, 50823, Cologne, Germany

    Thomas Elter, Janne J. Vehreschild, Oliver A. Cornely, Andreas Engert & Michael Hallek

  2. Cancer Research UK, Barts and the London School of Medicine, London, UK

    John Gribben

  3. Center for Clinical Trials, University of Cologne, Cologne, Germany

    Oliver A. Cornely

Authors
  1. Thomas Elter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Janne J. Vehreschild
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Gribben
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oliver A. Cornely
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andreas Engert
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Michael Hallek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Thomas Elter.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elter, T., Vehreschild, J.J., Gribben, J. et al. Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab. Ann Hematol 88, 121–132 (2009). https://doi.org/10.1007/s00277-008-0566-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-008-0566-9

Keywords

Search

Navigation