Complications du traitement de la leucémie lymphoïde chronique par Campath-1H (alemtuzumab ou MabCampath®) et par flavopiridol

Treatment of chronic lymphocytic leukaemia (CLL) is rapidly evolving, with emerging new drugs and new therapeutic associations. Campath-1H (alemtuzumab) is a monoclonal antibody recongnizing CD52 antigen, whose action is mainly mediated by ADCC (Antibody Dependant Cell Mediated Cytotoxicity) but also by complement activation and induction of apoptosis. Campath is approved in the treatment of relapsing-refractory CLL after fludarabine. The most frequent complications are infectious with frequent CMV, cocci Gram+ and herpes virus. These complications are especially observed in heavily pre-treated hypogammaglobulinemic patients. Pneumocystis carinii and herpes prophylaxis are recommended, and monitoring of CMV viral load is essential. General symptoms (fever, hypotension, nausea, cutaneous eruption…) during the perfusion may be severe and can be controlled by premedication including steroids. Subcutaneous route of administration seems better tolerated. Flavopiridol, a CDK inhibitor, have recently been tested in CLL. Early developments were disappointing; however, spectacular responses have been recently observed with new modalities of administration but with severe tumor lysis syndromes, which are exceptional in this disease.