Acute
graft-versus-host disease (aGVHD) and
cytomegalovirus reactivation are important
complications after allogeneic
stem cell transplantation (alloHSCT). Here, we evaluated the impact of
treatment with
alemtuzumab on the occurrence of aGVHD,
cytomegalovirus reactivation and
survival after alloHSCT. This was a prospective
cohort study conducted at the allo-HSCT unit of
Hospital das Clínicas, Universidade Federal de Minas Gerais,
Brazil , from January 2009 to December 2011. Fifty-seven
patients who underwent alloHSCT were included. Forty-five (79%)
patients had a malignant
disease .
Alemtuzumab was administered before the conditioning regimen at a
dose of 1 mg/kg in
children and 30 mg/day for 2 days in
adults or
children weighing more than 40 kg (a total
dose of 60 mg) with a non-malignant
disease or
patients with a malignant
disease and high-
risk for GVHD
mortality .
Alemtuzumab was used in 23 (40%)
patients , of whom 17 received a reduced-intensity conditioning. Eleven
patients presented aGVHD (grade 2–4) and only 1 of them received
alemtuzumab .
Cumulative incidence of aGVHD (grade 2–4) at day 100 after
transplantation (D+100) was 4 for
patients receiving
alemtuzumab and 29% for
patients not receiving
alemtuzumab .
Cumulative incidence of
cytomegalovirus reactivation for
patients receiving or not
alemtuzumab was 62 and 38%, respectively. Sixteen
patients died in the first 100 days after alloHSCT, most of them due to bacterial
sepsis . Only 2
patients died of aGVHD until D+100. Overall
survival was 50% without any impact of
alemtuzumab .
Alemtuzumab effectively controlled aGVHD but increased the
risk of
cytomegalovirus reactivation without improving
survival .