A Pilot Study of Alemtuzumab Plus Combination Chemotherapy for Newly Diagnosed Patients with Peripheral T-Cell Lymphomas.
Authors: Kim Jin Seok , Kim Soo-Jeong , Lee Hye Won , Yoon Sul Hee , Park In-Hae , Kim Yuri , Cheong June-Won , Min Yoo-Hong 
Published: April 2020

Abstract
The results of combination chemotherapy for peripheral T cell lymphoma (PTCL) still showed poor, although alemtuzumab monotherapy has therapeutic activity in PTCL. We evaluated the safety and effectiveness of several combination chemotherapies with alemtuzumab for treating newly diagnosed PTCL including advanced stage cutaneous T-cell lymphoma. Nine patients with PTCL were included. The pathologic subtypes were as follows: cutaneous T cell lymphoma (CTCL) in 2 patients, peripheral T cell lymphoma unspecified (PTCLu) in 2 patients, extranodal NK/T cell lymphoma, nasal type in 3 patients, angioimmunoblastic T cell lymphoma (AITL) in 2 patient. Patients received a 30mg of alemtuzumab intravenously over about 8 hours on the first day of combination chemotherapy. The combination chemotherapy regimens included: CHOP (cyclophosphamide, adriamycin, vincristine and prednisolone) in 2 patients; EPOCH (etoposide, prednisolone, vincristine, cyclophosphamide and adriamycin) in 2 patients; IMVP16-PL (ifosfamide plus mesna, methotrexate, etoposide and prednisolone) in 5 patients. Complete remission was achieved in 2 patients, and partial remission was achieved in 5 patients, only one patient encountered treatment related mortality (septic shock). Nine patients received nineteen cycles of alemtuzumab plus combination chemotherapy. Alemtuzumab infusion related adverse events were reported in 10 of 19 cycles and were mainly mild to moderate in severity. The most common events were shivers and chills during the alemtuzumab infusion period, which occurred in 8 of 19 cycles. Six (32%) cycles had one or more episodes of new onset NCI-CTC grade 3 or 4 anemia. In addition, erythropoietin use was reported in 7 patients. All of the cycles had grade 3 or 4 neutropenia and 8 (42%) cycles had grade 3 or 4 thrombocytopenia. Grade 3 hyponatremia and grade 3 or 4 hypokalemia were observed in 1 and 4 cycles, respectively. Ten cycles (53%) with neutropenic fever occurred during the treatments. Six (32%) sepsis, 1 septic shock, 2 pneumonia, 2 fungal infection and 2 herpes zoster were observed. There was no cytomegalovirus reactivation during the treatment. Although alemtuzumab plus combination chemotherapy had significant hematologic and infection complications, we concluded that alemtuzumab plus combination chemotherapy was well tolerated and could be recommended for treating newly diagnosed PTCL. However, evaluation in more patients with long-term follow up is warranted.
Patients characteristics Sex Age Stage Regimen Cycles Additional Tx Response 1Subcutaneous panniculitis T cell lymphom, 2Cutaneous gamma-delta T cell lymphoma, 3Extranodal T/NK cell lymphoma, nasal type, 4Radiotherapy, 5Treatment related mortality CTCL1 Female 22 IVA Alemtuaumab+EPOCH 3 RTx4 + 2 IMVP16-PL Partial remission CTCL2 Female 48 IIIA Alemtuaumab+IMVP16-PL 2 RTx4 Partial remission PTCLu Female 70 IIIA Alemtuaumab+CHOP 3 3 CHOP Complete remission PTCLu Female 50 IVB Alemtuaumab+IMVP16-PL 1 No Partial remission NK/T3 Male 51 IVB Alemtuaumab+IMVP16-PL 1 No Partial remission NK/T3 Male 46 IIEA Alemtuaumab+IMVP16-PL 3 RTx4 + 1 IMVP16-PL Complete remission NK/T3 Male 74 IIEA Alemtuaumab+CHOP 2 No TRM5(Sepsis) AITL Female 75 IIIB Alemtuaumab+EPOCH 2 No Progression AITL Male 70 IVB Alemtuaumab+IMVP16-PL 2 No Partial remission