Page 79 - Heart Transplant Protocol

Heart Function Service: Heart Transplant Protocols

Protocol for Administration of Alemtuzumab (Campath®)

Description: Alemtuzumab is a recombinant DNA-derived humanized monoclonal antibody directed
against CD52. CD52 is an antigen present on the surface of B and T lymphocytes, a majority of
monocytes, macrophages, NK cells and granulocytes(<5%) and absent on erythrocytes, platelets and
hematopoietic stem cells. A proportion of bone marrow cells, including some CD34+ cells, express
variable levels of CD52. The proposed mechanism of action is antibody-dependent cellular-mediated
lysis of lymphocytes.

Indication: Approved as a single agent for the treatment of B-cell chronic lymphocytic leukemia (B-CLL).
Also, used in solid organ transplant for induction & rejection (off-label).

Dose:
Children: 1mg/kg subcutaneously x 1, max dose: 30mg
Adult: 30mg subcutaneously x 1

Administration:
 Preparation: No dilution needed
 Premedication:
o Acetaminophen 15 mg/kg (max 650 mg) PO x 1
o Diphenhydramine 1 mg/kg (max 50 mg) IV or PO x 1
o Methylprednisolone, none, intra-operative dose sufficient
 Administration: Administer subcutaneously in either buttocks or thighs post-transplantation.
 Prophylaxis: Antiviral, antibacterial, antimycobacterium and antifungal prophylaxis should be
initiated after receiving Alemtuzumab

Monitoring:
 Check CBC with differential before transplant, post-transplant, weekly x first month, then
monthly x 12 months
3
st
 Check CD4 weekly for the 1 2 weeks; if CD4 persistently < 50 cells/mm , recheck CD4 every 3
month
 CMV, EBV and BK checked monthly for the first 6 months, then annually
 If bone marrow suppression occurs, as defined by WBC <3000, Hct<30% and/or platelet counts
<75, 000, consider discontinue/decrease mycophenolate, valganciclovir, valacyclovir, PPI and/or
bactrim.
Stability: Use within 8 hours after dilution. Store diluted Alemtuzumab at room temperature (15-30°C)
or refrigerated (2-8°C). Protect from light
Side Effects: Most common adverse reactions (≥ 10%): cytopenias (lymphocyte could be suppressed for
up to 1 year), infusion reactions, CMV and other infections, nausea, emesis, diarrhea, and insomnia
Reference:
1. Product Information: CAMPATH(R) IV solution for injection, alemtuzumab IV solution for injection.
Genzyme Corp, Cambridge, MA, 2007.
2. Vo AA, Wechsler EA, Wang J, et al. Analysis of subcutaneous(SQ) Alemtuzumab Induction Therapy in
Highly Sensitized Patients Desensitized With IVIG and Rituximab. American Journal of Transplantation
2008; 8: 144–149.
3. Bartosh SM, Knechtle SJ, Sollinger HW. Campath-1H Use in Pediatric Renal Transplantation. American
Journal of Transplantation 2005;5:1569-1573.

Updated November 9, 2017 79