Assessment

• Monitor for infusion reactions (hypotension, rigors, fever, shortness of breath, bronchospasm, chills, rash). Premedicate with an oral antihistamine and acetaminophen 30 min prior to initial dose, dose increases, and as clinically indicated. Monitor blood pressure and hypotensive symptoms in patients with ischemic heart disease with extra care. Antihistamines, acetaminophen, antiemetics, meperidine, corticosteroids, and incremental dose escalation have been used to prevent and treat infusion-related reactions. Initiate therapy at lowest dose and increase gradually. If therapy is interrupted for 7 or more days, reinstitute with gradual dose escalation

• Obtain CBC and platelet counts weekly during therapy and more frequently if worsening anemia, neutropenia, or thrombocytopenia is observed. For first occurrence of ANC<250 cells/mm³ and/or platelet count <25,000 cells/mm³, withhold alemtuzumab therapy. When ANC >500 cells/mm³ and platelet count is >50,000 cells/mm³, resume at same dose. If delay of 7 days or more occurred initiate therapy at 3 mg and escalate to 10 mg and then to 30 mg as tolerated. For second occurrence of ANC <250 cells/mm³ and/or platelet count <25,000 cells/mm³, withhold alemtuzumab. When ANC >500 cells/mm³ and platelet count >50,000 cells/mm³, resume therapy at 10 mg. If delay is 7 days or more, initiate therapy at 3 mg and escalate to 10 mg only. For third occurrence of ANC <250 cells/mm³ and/or platelet count <25,000 cells/mm³, discontinue alemtuzumab therapy permanently. For a decrease of ANC and/or platelet count of 50% of baseline value in patients initiating therapy with a baseline ANC of <500 cells/mm³ and/or a baseline platelet count of 25,000 cells/mm³, withhold therapy. When baseline levels return, resume therapy. If delay is 7 days or more, initiate therapy at 3 mg and escalate to 10 mg and 30 mg as tolerated

» Assess CD4 counts after treatment until recovery to >=200 cells cells/mm³

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