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Alemtuzumab (Campath®)

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OncoLink
Last Modified: September 8, 2011

Pronounced: AL-em-TOOZ-oo-mab
Classification: Monoclonal antibody

About Alemtuzumab

Alemtuzumab is a synthetic (man made) antibody directed against a protein called CD52, found on the surface of some cells. Antibodies, which are normally found in the body, are developed by the immune system to destroy foreign material (such as a germ). In this case, Alemtuzumab is drawn to white blood cells that have the CD52 protein on them. These include normal and malignant (cancerous) B and T lymphocytes, natural killer cells, monocytes, macrophages, and some tissues of the male reproductive system. The drug binds to the surface and causes cell death. Some of the side effects of Alemtuzumab are caused by the treatment's effect on normal cells.

How to Take Alemtuzumab

Alemtuzumab is given by intravenous (into a vein) infusion, over two hours. Generally, a dose is given three times a week. The first few doses are typically given in a dose-escalation format, until the recommended dose is reached. This means that on the first day of treatment you are given a very low dose. If you don't have any serious side effects, you will be given a slightly higher dose the following treatment day, and so on. Most patients are able to reach the recommended dose in 3 to 7 treatments. Treatment tends to last for about 12 weeks total.

You will receive acetaminophen (Tylenol) and diphenhydramine prior to the infusion to prevent a reaction. Most patients will also be given medications called Bactrim, to prevent pneumocysitis pneumonia (PCP), and famcyclovir, to prevent herpes infection.

Possible Side Effects of Alemtuzumab

There are a number of things you can do to manage the side effects of Alemtuzumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Infusion-Related Side Effects

The infusion can cause a reaction that may lead to chills, fever, low blood pressure, nausea and vomiting. You will receive Tylenol and diphenhydramine prior to the infusion to help prevent these reactions. Some patients will also receive a steroid before the infusion to prevent a reaction. Reactions are most common during the first week of therapy, including the evening after the infusion. Your doctor or nurse will tell you what to do if this happens.

Low White Blood Cell Count (Leukopenia or Neutropenia)

White blood cells (WBC) are important for fighting infection. While receiving treatment, your WBC count can drop, putting you at a higher risk of getting an infection. You should let your doctor or nurse know right away if you have a fever (temperature greater than 100.4 F), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.

Tips to preventing infection:

• Washing hands, both yours and your visitors, is the best way to prevent the spread of infection.
• Avoid large crowds and people who are sick (i.e.: those who have a cold, fever or cough or live with someone with these symptoms).
• When working in your yard, wear protective clothing including long pants and gloves.
• Do not handle pet waste.
• Keep all cuts or scratches clean.
• Shower or bath daily and perform frequent mouth care.
• Do not cut cuticles or ingrown nails. You may wear nail polish, but not fake nails.
• Ask your doctor or nurse before scheduling dental appointments or procedures.
• Ask your doctor or nurse before you, or someone you live with, has any vaccinations.

For more suggestions, read the Neutropenia Tip Sheet.

Low Red Blood Cell Count (Anemia)

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your doctor or nurse know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion. Read the anemia tip sheet for more information.

Low Platelet Count (Thrombocytopenia)

Platelets help your blood clot, so when the platelet count is low, you are at a higher risk of bleeding. Let your doctor or nurse know if you have any excess bruising or bleeding, including nosebleeds, bleeding gums or blood in your urine or stool. If the count becomes too low, you may be given a transfusion of platelets.

• Do not use a razor to shave (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal anti-inflammatory medications (NSAIDs) such as Motrin®, Aleve®, Advil®, as these can all increase the risk of bleeding. Unless your healthcare team tells you otherwise, you may take acetaminophen (Tylenol).
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Read the thrombocytopenia tip sheet for more information.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Fatigue

See OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Muscle or Joint Pain/Aches and Headache

Your doctor or nurse can recommend medication and other strategies to relive pain.

Decrease in Appetite

Visit OncoLink's section on Nutrition for tips on dealing with this side effect. Ask your nurse about nutritional counseling services.

• Try to eat five or six small meals or snacks throughout the day, instead of 3 larger meals.
• If you are not eating enough, nutritional supplements may help.
• You may experience a metallic taste or dislike foods or beverages that you liked before receiving chemotherapy. These symptoms can last several months after treatment.
• Avoid any food that you think smells or tastes bad. If red meat is a problem, eat chicken, turkey, eggs, dairy products and fish without a strong smell.
• Flavor meat or fish by marinating it in sweet juices, sweet and sour sauce or dressings. Use seasonings like basil, oregano or rosemary to add flavor. Bacon, ham and onion can also add flavor to vegetables.

Other Side Effects

Abdominal pain, cough, rash, and itching.