New Zealand Formulary
Menu Close Menu

Fewer cancers.
Better survival.
Equity for all.

Systemic Anti-Cancer Therapy Regimen Library

Home > LEU CLL Relapsed - aLEMTUzumab [IV]

LEU CLL Relapsed - aLEMTUzumab [IV]

Treatment Overview

Subcutaneous administration of aLEMTUzumab is associated with fewer administration-related reactions and may be the preferred route of administration.

Cycle 1 - 7 days

Cycle length:
7
  • Day 1 is Monday.
  • If treatment is interrupted for more than 7 days for any reason, re-initiate aLEMTUzumab at 3 mg, and escalate as above.
  • Alternative schedules for cycle 1:
  • aLEMTUZumab 3 mg day 3 (Wednesday), 10 mg day 4 (Thursday) and 30 mg day 5 (Friday);
  • aLEMTUzumab 3 mg day 1 (Monday), 10 mg day 3 (Wednesday) and 30 mg day 5 (Friday). 

Cycles 2 to 12 - 7 days

Cycle length:
7

If treatment is interrupted for more than 7 days for any reason, re-initiate aLEMTUzumab at 3 mg, and escalate as per Cycle 1.

Cycle details

Cycle 1 - 7 days

Medication Dose Route Days Max Duration
dexamethasone * 8 mg flat dosing intravenous 1, 2, 3 15 minutes
paracetamol 1000 mg flat dosing oral administration 1, 2, 3,
5
loratadine * 10 mg oral administration 1, 2, 3,
5
aLEMTUzumab 3 mg flat dosing intravenous 1 120 minutes
aLEMTUzumab 10 mg flat dosing intravenous 2 120 minutes
aLEMTUzumab 30 mg flat dosing intravenous 3, 5 120 minutes
  • Day 1 is Monday.
  • If treatment is interrupted for more than 7 days for any reason, re-initiate aLEMTUzumab at 3 mg, and escalate as above.
  • Alternative schedules for cycle 1:
  • aLEMTUZumab 3 mg day 3 (Wednesday), 10 mg day 4 (Thursday) and 30 mg day 5 (Friday);
  • aLEMTUzumab 3 mg day 1 (Monday), 10 mg day 3 (Wednesday) and 30 mg day 5 (Friday). 

Cycles 2 to 12 - 7 days

Medication Dose Route Days Max Duration
paracetamol 1000 mg flat dosing oral administration 1, 3, 5
loratadine * 10 mg oral administration 1, 3, 5
aLEMTUzumab 30 mg flat dosing intravenous 1, 3, 5 120 minutes

If treatment is interrupted for more than 7 days for any reason, re-initiate aLEMTUzumab at 3 mg, and escalate as per Cycle 1.

Full details

Cycle 1 - 7 days

Day: 1

Medication Dose Route Max duration Details
dexamethasone * 8 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to aLEMTUzumab, or as per institutional practice.
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 3 mg flat dosing intravenous 120 minutes

Day: 2

Medication Dose Route Max duration Details
dexamethasone * 8 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to aLEMTUzumab, or as per institutional practice.
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 10 mg flat dosing intravenous 120 minutes

Day: 3

Medication Dose Route Max duration Details
dexamethasone * 8 mg flat dosing intravenous 15 minutes
Instructions:

ONE hour prior to aLEMTUzumab, or as per institutional practice.
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 30 mg flat dosing intravenous 120 minutes

Day: 5

Medication Dose Route Max duration Details
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 30 mg flat dosing intravenous 120 minutes

Cycles 2 to 12 - 7 days

Day: 1

Medication Dose Route Max duration Details
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 30 mg flat dosing intravenous 120 minutes

Day: 3

Medication Dose Route Max duration Details
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 30 mg flat dosing intravenous 120 minutes

Day: 5

Medication Dose Route Max duration Details
paracetamol 1000 mg flat dosing oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
loratadine * 10 mg oral administration
Instructions:
ONE hour prior to aLEMTUzumab.
aLEMTUzumab 30 mg flat dosing intravenous 120 minutes

Supportive Care Factors

Factor Value
Antifungal prophylaxis: Routine antifungal prophylaxis recommended
Antiviral prophylaxis for hepatitis B virus: Required for anti–HBc positive patients at risk of reactivation
Antiviral prophylaxis for herpes virus: Routine antiviral prophylaxis recommended
CMV monitoring: Recommended
Emetogenicity: Minimal
Hypersensitivity / Infusion related reaction risk: High - routine premedication recommended
Irradiated blood components: Irradiation of blood components is recommended
Pneumocystis jirovecii pneumonia (PJP) prophylaxis: Routine antibiotic prophylaxis recommended
Tumour lysis syndrome prophylaxis: Tumour lysis syndrome prophylaxis is recommended

Tumour lysis syndrome prophylaxis: Recommended for the first 7 to 14 days.

References

Sanofi-Aventis Australia Pty Ltd MABCAMPATH Australian Product Information Sheet 23 December 2021 https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2011-PI-01413-3&d=20220111172310101 (accessed 20 January 2022).

Osterborg A, Karlsson C, Lundin J, et al. Strategies in the management of alemtuzumab-related side effects. Semin Oncol 2006;33(2 Suppl 5):S29-35. , PMID: 16720201

Keating et al. Therapeutic role of alemtuzumab (Campath IH) in patients who have failed fludarabine: results of a large international study. Blood 2002;99:3554-61. , PMID: 11986207

Lozanski G, Heerema NA, Flinn IW, Smith L, Harbison J, Webb J, Moran M, Lucas M, Lin T, Hackbarth ML, Proffitt JH, Lucas D, Grever MR, Byrd JC. Alemtuzumab is an effective therapy for chronic lymphocytic leukemia with p53 mutations and deletions. Blood. 2004 May 1;103(9):3278-81. doi: 10.1182/blood-2003-10-3729. Epub 2004 Jan 15. , PMID: 14726385

Faderl S, Ferrajoli A, Wierda W, O'Brien S, Lerner S, Keating MJ. Alemtuzumab by continuous intravenous infusion followed by subcutaneous injection plus rituximab in the treatment of patients with chronic lymphocytic leukemia recurrence. Cancer. 2010 May 15;116(10):2360-5. doi: 10.1002/cncr.24958. Erratum in: Cancer. 2010 Aug 15;116(16):3982. Dosage error in article text., PMID: 20225334

British Columbia Cancer Agency Cancer Drug Manual Alemtuzumab 1 August 2021 http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Alemtuzumab_monograph.pdf (Accessed 16 May 2022).

Doyle J, Raggatt M, Slavin M, McLachlan SA, Strasser SI, Sasadeusz JJ, Howell J, Hajkowicz K, Nandurkar H, Johnston A, Bak N, Thompson AJ. Hepatitis B management during immunosuppression for haematological and solid organ malignancies: an Australian consensus statement. Med J Aust. 2019 Jun;210(10):462-468, PMID: 31104328

* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.

s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.