Alternative to Antiviral Prophylaxis for CMV in Campath®-treated CLL Patients

For physicians who treat chronic lymphocytic leukemia (CLL), the approval of Campath® for first-line therapy is encouraging. Campath is indicated for the treatment of B-cell CLL (BCLL) in patients who have been treated with alkylating agents and who have failed fludarabine therapy. However, Campath does come with some potential inherent risks.

In published clinical studies, single-agent Campath (alemtuzumab) was associated with an incidence of symptomatic CMV reactivation ranging from 4 to 29%. ¹ This incidence may be clinically significant. As a result, some oncologists proactively prescribe a regimen of antiviral drug(s). While this is an acceptable course of treatment, in this age of awareness of the overuse of antibiotics and other drugs, this choice may not be the best first response. For example, if the worst case does exist and 29% of CLL patients reactivate CMV, then 71% of patients are receiving an additional, unnecessary drug.

Another consideration is that many insurance companies closely monitor and critically evaluate prophylactic therapy. The cost of antiviral drugs to combat CMV exceeds thousands of dollars over the course of Campath treatment.

There is another consideration. ViraCor offers reliable, validated, cost-effective testing for CMV and has established a well-deserved reputation of providing the highest quality, quantitative test results within 24 hours. Our 24-hour turnaround time enables oncologists to begin antiviral treatment in a timely manner, if appropriate. In addition, quantitative results allow the physician to monitor the effectiveness of the treatment.

Contact us for more information on this alternative to prophylactic treatment.

1. Campath (alemtuzumab) Package Insert. Bayer HealthCare Pharmaceuticals.

Selected References:

Ferrajoli A, O'Brien SM, Cortes JE, et al. Phase II study of alemtuzumab in chronic lymphoproliferative disorders. Cancer.2003;98:773-778.

Hiimen P, Skotnicki A, Robak T, et al. Alemtuzumab (CAMPATH®, MABCAMPATH®) has superior progression free survival (PFS) vs chlorambucil as front-line therapy for patients with progressive B-cell chronic lymphocytic leukemia (BCLL). Blood. 2006;108:93a (Abstract #301).

Keating MJ, Flinn I, Jain V, et al. Therapeutic role of alemtuzumab (Campath-1H) in patients who have failed fludarabine: results of a large international study. Blood. 2002;99:3554-3561.

Lundin J, Kimby E, Björkholm M, et al. 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. 2002;100(3):768-773.

Moreton P, Kennedy B, Lucas G, et al. Eradication of minimal residual disease in b-cell chronic lymphocytic leukemia after alemtuzumab therapy is associated with prolonged survival. J Clin Oncol. 2005;23:2971-2979.

Nguyen DD, Cao TM, Dugan K, et al. Cytomegalovirus viremia during Campath-1H therapy for relapsed and refractory chronic lymphocytic leukemia and prolymphocytic leukemia. Clin Lymphoma. 2002;3:105-110.

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