Skip to main content

Advertisement

SpringerLink
Log in

Subcutaneous alemtuzumab plus cyclosporine for the treatment of aplastic anemia

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

Abstract

Aplastic anemia (AA) is most frequently due to autoimmune attack on its own stem cells. Alemtuzumab is a monoclonal antibody which recognizes the CD52 antigen on the surface of T and B cells. It has proved useful in autoimmune diseases, lymphoproliferative conditions, and graft versus host disease. Based on its immunosuppressive properties, we treated 14 AA patients with alemtuzumab. Median age was 23 years. Ten milligrams of alemtuzumab were injected subcutaneously each day for five consecutive days. Cyclosporine A was also administered orally at a dose of 2 mg/kg every 12 h for 3 months, and then gradually tapered. Response to alemtuzumab was followed for a median of 20 months. There were eight responses (57.1%), two complete and six partial. Whereas six (42.8%) patients were non-responders. Median complete blood count values on alemtuzumab responders were Hb 13.1 mg/dL, absolute neutrophil count 2.4 × 109/L, and platelets 97.5 × 109/L. A good response was produced in 57% of AA patients with the administration of alemtuzumab, who lacked a stem cell donor.

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. Marsh J (2006) Making therapeutic decisions in adults with aplastic anemia. Hematology Am Soc Hematol Educ Program 2006:78–85

    Google Scholar 

  2. Young NS, Calado RT, Scheinberg P (2006) Current concepts in the pathophysiology and treatment of aplastic anemia. Blood 108:2509–2519

    Article  CAS  PubMed  Google Scholar 

  3. Marsh JC, Ball SE, Darbyshire P et al (2003) Guidelines for the diagnosis and management of acquired aplastic anaemia. Br J Haematol 123:782–801

    Article  CAS  PubMed  Google Scholar 

  4. Jaime-Perez JC, Ruiz-Arguelles GJ, Gomez-Almaguer D (2005) Haematopoietic stem cell transplantation to treat aplastic anaemia. Expert Opin Biol Ther 5:617–626

    Article  PubMed  Google Scholar 

  5. Brodsky RA, Jones RJ (2005) Aplastic anaemia. Lancet 365:1647–1656

    Article  CAS  PubMed  Google Scholar 

  6. Johnston B, Conly J (2006) Alemtuzumab and natalizumab: the monoclonal antibody story continues. Can J Infect Dis Med Microbiol 17:327–329

    PubMed  Google Scholar 

  7. Villamor N, Montserrat E, Colomer D (2003) Mechanism of action and resistance to monoclonal antibody therapy. Semin Oncol 30:424–433

    Article  CAS  PubMed  Google Scholar 

  8. Willis F, Marsh JC, Bevan DH et al (2001) The effect of treatment with Campath-1H in patients with autoimmune cytopenias. Br J Haematol 114:891–898

    Article  CAS  PubMed  Google Scholar 

  9. Marsh JC (2007) Treatment of acquired aplastic anemia. Haematologica 92:2–5

    Article  CAS  PubMed  Google Scholar 

  10. Issaragrisil S, Kaufman DW, Anderson T et al (2006) The epidemiology of aplastic anemia in Thailand. Blood 107:1299–1307

    Article  CAS  PubMed  Google Scholar 

  11. Kaufman DW, Kelly JP, Jurgelon JM et al (1996) Drugs in the aetiology of agranulocytosis and aplastic anaemia. Eur J Haematol 60:23–30

    CAS  Google Scholar 

  12. Montane E, Ibanez L, Vidal X et al (2008) Epidemiology of aplastic anemia: a prospective multicenter study. Haematologica 93:518–523

    Article  PubMed  Google Scholar 

  13. Ruiz-Arguelles GJ, Gomez-Rangel JD (2003) Long-term results of the immunosuppressive treatment of patients with severe acquired aplastic anemia: a single institution study. Acta Haematol 110:184–187

    Article  PubMed  Google Scholar 

  14. Benitez-Aranda H, Velez-Ruelas MA, Diaz-Cardenas S et al (2002) Incidence of aplastic anemia in a defined subpopulation from Mexico City. Hematology 7:229–232

    Article  PubMed  Google Scholar 

  15. Storb R, Leisenring W, Anasetti C et al (1997) Long-term follow-up of allogeneic marrow transplants in patients with aplastic anemia conditioned by cyclophosphamide combined with antithymocyte globulin. Blood 89:3890–3891

    CAS  PubMed  Google Scholar 

  16. Frickhofen N, Heimpel H, Kaltwasser JP, Schrezenmeier H (2003) Antithymocyte globulin with or without cyclosporin A: 11-year follow-up of a randomized trial comparing treatments of aplastic anemia. Blood 101:1236–1242

    Article  CAS  PubMed  Google Scholar 

  17. Jaime-Perez JC, Gonzalez-Llano O, Gomez-Almaguer D (2001) High-dose cyclophosphamide in the treatment of severe aplastic anemia in children. Am J Hematol 66:71

    Article  CAS  PubMed  Google Scholar 

  18. Brodsky RA, Sensenbrenner LL, Smith BD et al (2001) Durable treatment-free remission after high-dose cyclophosphamide therapy for previously untreated severe aplastic anemia. Ann Intern Med 135:477–483

    CAS  PubMed  Google Scholar 

  19. Chao MM, Levine JE, Ferrara JL et al (2008) Successful treatment of refractory immune hemolysis following unrelated cord blood transplant with Campath-1H. Pediatr Blood Cancer 50:917–919

    Article  PubMed  Google Scholar 

  20. Laros-van Gorkom BA, Huisman CA, Wijermans PW, Schipperus MR (2007) Experience with alemtuzumab in treatment of chronic lymphocytic leukaemia in the Netherlands. Neth J Med 65:333–338

    CAS  PubMed  Google Scholar 

  21. Hale G, Rebello P, Brettman LR et al (2004) Blood concentrations of alemtuzumab and antiglobulin responses in patients with chronic lymphocytic leukemia following intravenous or subcutaneous routes of administration. Blood 104:948–955

    Article  CAS  PubMed  Google Scholar 

  22. Au WY, Lam CC, Chim CS, Pang AW, Kwong YL (2005) Alemtuzumab induced complete remission of therapy-resistant pure red cell aplasia. Leuk Res 29:1213–1215

    Article  CAS  PubMed  Google Scholar 

  23. Rzepecki P, Sarosiek T, Szczylik C (2006) Alemtuzumab, fludarabine and melphalan as a conditioning therapy in severe aplastic anemia and hypoplastic myelodysplastic syndrome—single center experience. Jpn J Clin Oncol 36:46–49

    Article  PubMed  Google Scholar 

  24. Gómez-Almaguer D, Ruiz-Argüelles GJ, del Carmen Tarín-Arzaga L et al (2008) Alemtuzumab for the treatment of steroid-refractory acute graft-versus-host disease. Biol Blood Marrow Transplant 14:10–15

    Article  PubMed  Google Scholar 

  25. Ruiz-Argüelles GJ, Gil-Beristain J, Magaña M, Ruiz-Delgado GJ (2008) Alemtuzumab-induced resolution of refractory cutaneous chronic graft versus host disease. Biol Bone Marrow Transplant 14:7–9

    Article  Google Scholar 

  26. Kim H, Min YJ, Baek JH, Shin SJ, Lee EH, Noh EK, Kim MY, Park JH et al (2009) A pilot dose-escalating study of alemtuzumab plus cyclosporine for patients with bone marrow failure syndrome. Leuk Res 33:222–231

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hospital Universitario José Eleuterio González, Monterrey, NL, Mexico

    David Gómez-Almaguer, José Carlos Jaime-Pérez, Verónica Garza-Rodríguez, Adrián Chapa-Rodríguez, Luz Tarín-Arzaga, José Luís Herrera-Garza, Oscar González-Llano & Laura Rodríguez-Romo

  2. Centro de Hematología y Medicina Interna de Puebla, Puebla, PUE, Mexico

    Guillermo J. Ruiz-Argüelles & Avril López-Otero

  3. Laboratorios Clínicos de Puebla, Puebla, PUE, Mexico

    Guillermo J. Ruiz-Argüelles

  4. Servicio de Hematología, Centro Universitario Contra el Cáncer, Hospital Universitario “Dr. José E. González”, Ave. Madero y Gonzalitos S/N, Colonia Mitras Centro, Monterrey, NL, C.P. 64460, Mexico

    David Gómez-Almaguer

Authors
  1. David Gómez-Almaguer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. José Carlos Jaime-Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Verónica Garza-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adrián Chapa-Rodríguez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luz Tarín-Arzaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. José Luís Herrera-Garza
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Guillermo J. Ruiz-Argüelles
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Avril López-Otero
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Oscar González-Llano
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Laura Rodríguez-Romo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David Gómez-Almaguer.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gómez-Almaguer, D., Jaime-Pérez, J.C., Garza-Rodríguez, V. et al. Subcutaneous alemtuzumab plus cyclosporine for the treatment of aplastic anemia. Ann Hematol 89, 299–303 (2010). https://doi.org/10.1007/s00277-009-0816-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-009-0816-5

Keywords

Search

Navigation