Update of alemtuzumab in the treatment of chronic lymphocytic leukaemia

Introduction Chronic lymphocytic leukaemia (CLL) is the commonest of the adult leukaemias in the western world. The clinical course is highly variable with some patients surviving decades without requiring therapy whilst others have more aggressive disease requiring immediate treatment and associated with a shortened survival. Conventional treatment has relied on alkylating agents such as chlorambucil and, more recently, purine analogues such as a fludarabine. As single agents these therapies achieve good overall response rates (OR) of up to 80% but with complete remission rates (CR) of <10% for chlorambucil and 15-20% for single agent fludarabine. Combinations of these drugs, such as fludarabine together with cyclophosphomide, have shown increase in complete remission rates up to 40% with a prolongation of progression-free survival (PFS).1 However, none of the randomised studies have shown any survival advantage. This latter observation is largely due to the ability to successfully re-treat relapsed patients. However, patients who become refractory to alkylator and fludarabine based treatments have traditionally had a very poor response (<20%) to salvage therapy and a greatly shortened survival (median 10 months).2