Alemtuzumab

INTRODUCTION

Indications

Treatment of B-cell chronic lymphocytic leukemia in patients who have been treated with alkylating agents and in whom fludarabine therapy has failed.

Action

Binds to the CD52 antigen found on the surface of B and T lymphocytes and other white blood cells; resulting in lysis. Therapeutic Effects: Lysis of leukemic cells with eventual improvement in hematologic parameters.

Adverse Reactions/Side Effects

CNS: depression, dizziness, drowsiness, fatigue, headache, weakness. Resp: bronchospasm, cough, dyspnea. CV: hypertension, hypotension, tachycardia. GI: abdominal pain, anorexia, constipation, stomatitis. Derm: rash, sweating. F and E: edema. Hemat: NEUTROPENIA, PANCYTOPENIA/MARROW HYPOPLASIA, anemia, lymphopenia, thrombocytopenia. MS: back pain, skeletal pain. Misc: infusion-related events, infection, sepsis.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of bone marrow suppression, including neutropenia (fever, sore throat, signs of infection), thrombocytopenia (bruising, nose bleeds, bleeding gums), or unusual weakness and fatigue that might be due to anemia or other blood dyscrasias. Report these signs to the physician or nursing staff immediately.

• Report allergy-like responses (wheezing, tightness in the throat or chest, urticaria, other skin reactions) that occur during and after administration (infusion-related events).

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension), or a sustained increase in BP (hypertension).

• Assess heart rate (HR), ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid HR rate (tachycardia) or signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

• Monitor signs of bronchospasm (wheezing, coughing, tightness in chest) or other prolonged or severe respiratory problems (difficult or labored breathing). Perform pulmonary function tests and monitor breath sounds to quantify suspected changes in ventilation and respiration (See Appendices I, J, K).

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Assess any joint, back, or other skeletal pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness, drowsiness, or weakness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor and report depression or other changes in mood and behavior.

Interventions

• For patients who are medically able to begin exercise, implement appropriate resistive exercises and aerobic training to ...