The use of alemtuzumab (Campath 1H) in organ transplant recipients

Abstract

Purpose of review: Alemtuzumab (Campath 1H) is a powerful lympholytic monoclonal antibody, which is only effective against human lymphocytes. It has been used in a number of autoimmune diseases and has had especially good results in the management of chronic lymphatic leukemia. Recent findings: Recent studies and clinical trials have defined optimal modes of administration of the antibody. The principle is to give one or two doses to the patient in the perioperative part of the organ transplant as a preemptive strike. T and B lymphocytes are banished from the circulation for approximately 1 month. Advantage is taken of this period of relative immuno-incompetence to establish maintenance immunosuppression at a very low dose. Half the normal dose of one calcineurin inhibitor is sufficient to maintain good organ function without the need for conventional immunosuppression. In particular corticosteroids can be avoided in most patients. This contributes to a good quality of life. The protocol is much cheaper than conventional immunosuppression and long-term follow-up has given encouraging results. Summary: A monoclonal antibody that targets the lymphocyte surface antigen CD52 was recently developed for use in humans. In clinical trials the antibody was shown to have striking effects on lymphocytes being responsible for a drastic reduction in lymphocyte numbers within the very first few hours after infusion. Lymphocyte depletion is maintained for several weeks despite only two doses of the antibody being administered. This affords maintenance immunosuppressive regimen in which significantly less drugs are used, which results in better tolerability and less costs. © 2005 Lippincott Williams & Wilkins.