Alemtuzumab in the up-front setting

Alemtuzumab is a humanized chimeric monoclonal antibody targeting CD52. Although this agent already has an important role in the treatment of chronic lymphocytic leukemia (CLL), many of its uses are still being defined. Early trials showed alemtuzumab’s value in refractory disease and helped to define its excellent activity in the bone marrow, spleen and 17p deleted patients. The CAM307 trial has demonstrated alemtuzumab’s efficacy as monotherapy in the front-line setting, and ultimately led to its FDA approval as frontline therapy. Especially promising is the trend toward improved response in patients with high risk cytogenic abnormalities (17p del, 11q del, trisomy 12). The various consolidation trials have also provided promising results of achieving eradication of minimal residual disease (MRD). Although the ultimate benefit of achieving MRD negativity remains under investigation, alemtuzumab’s potent activity on the bone marrow will likely make it an important part of combination therapy.