Classification: monoclonal antibody
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
There are a number of things you can do to manage the side effects of alemtuzumab. Talk to your healthcare team 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), sore throat or cold, shortness of breath, cough, burning with urination, or a sore that doesn't heal.
Tips to preventing infection:
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.
Low Platelet Count (Thrombocytopenia)
Platelets help your blood clot, so when the 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 nose bleeds, bleeding gums or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. 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.
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.
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 and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
Because this medication can lower your blood counts and immune system function, you may be at higher risk for infections including pneumocystis pneumonia (PCP), herpes (HSV) and cytomegalovirus (CMV). You will be prescribed medications to prevent some infections, but not all infections can be prevented. If you develop of fever, report this to your healthcare team immediately.
This medication can cause cardiac dysrhythmias, in particular tachycardia, usually associated with infusion. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.
You, and individuals who you live with, should not receive vaccines that contain live virus, including oral polio, measles, or the nasal flu vaccine (FluMist) while you are receiving this medication. Vaccines may not work as well as they should while taking this medication. Discuss this with your provider before receiving any vaccines.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 6 months after treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.
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