Optimising alemtuzumab therapy for refractory B cell @entity6444 ( XXXX ).

@entity1 @entity1667 @entity41 @entity3726 @entity3118 @entity6444
UNASSIGNED: 6522 Background: Approximately half of @entity6444 @entity1 do not respond to alemtuzumab and others progress after responding to alemtuzumab. We report here factors predictive for lack of response and approaches to achieve the best outcome for these @entity1 . METHODS: 91 @entity1 with relapsed or @entity6444 received alemtuzumab aiming for @entity41 ( @entity41 ) negativity. Factors correlated with response were reviewed and strategies for overcoming resistance or relapse are reported. RESULTS: The chance of response was associated with lymph node size (p <0.0001): [Figure: see text] High dose @entity1667 (HDMP; 1g/m(2)/day x5 every 4 weeks; 4 @entity1 ) or @entity3726 (1) were used to reduce bulky nodes prior to alemtuzumab. 2 of 5 had a resolution of lymph nodes with both achieving @entity41 negative remissions with alemtuzumab. The other 3 did not respond to HDMP or alemtuzumab. 8 @entity1 refractory to alemtuzumab, due to bulky lymph nodes, received alemtuzumab with concurrent @entity3118 and 6 responded (2 @entity41 negative, 2 CR, 2 PR). In addition, 9 @entity1 relapsing after a median of 23 months (range 8-46) from alemtuzumab were retreated of which 5 responded (1 @entity41 negative, 2 CR, 2 PR): 2 of the non-responders then received alemtuzumab combined with @entity3118 with 1 achieving @entity41 negativity. One @entity1 was treated on relapse directly with the alemtuzumab/ @entity3118 combination and achieved a @entity41 negative CR. Thus 11 refractory @entity1 received combined alemtuzumab and @entity3118 with 8 responding (4 @entity41 negative, 2 CR, 2 PR). CONCLUSIONS: Gross lymphadenopathy predicts for poor response to alemtuzumab but therapy with HDMP or @entity3726 followed by alemtuzumab can be effective in achieving @entity41 negative CR. The majority of alemtuzumab refractory @entity1 (8/11) respond to the addition of @entity3118 . Retreatment with alemtuzumab was effective for 3 of 7 relapsing @entity1 . [Table: see text].
