"The U.S. Food and Drug Administration today expanded the approved use of Imbruvica (ibrutinib) for chronic lymphocytic leukemia (CLL) patients who have received at least one previous therapy.
CLL is a rare blood and bone marrow disease"...
Campath is indicated as a single agent for the treatment of B-cell chronic lymphocytic leukemia (B-CLL).
DOSAGE AND ADMINISTRATION
Dosing Schedule And Administration
- Administer as an IV infusion over 2 hours. Do not administer as intravenous push or bolus.
- Recommended Dosing Regimen
- Gradually escalate to the maximum recommended single dose of 30 mg. Escalation is required at initiation of dosing or if dosing is held ≥ 7 days during treatment. Escalation to 30 mg ordinarily can be accomplished in 3 – 7 days.
- Escalation Strategy:
- Administer 3 mg daily until infusion reactions are ≤ grade 2 [see ADVERSE REACTIONS].
- Then administer 10 mg daily until infusion reactions are ≤ grade 2.
- Then administer 30 mg/day three times per week on alternate days (e.g., Mon-Wed-Fri). The total duration of therapy, including dose escalation, is 12 weeks.
- Single doses of greater than 30 mg or cumulative doses greater than 90 mg per week increase the incidence of pancytopenia.
Recommended Concomitant Medications
- Premedicate with diphenhydramine (50 mg) and acetaminophen (500-1000 mg) 30 minutes prior to first infusion and each dose escalation. Institute appropriate medical management (e.g. steroids, epinephrine, meperidine) for infusion reactions as needed [see BOXED WARNING, WARNINGS AND PRECAUTIONS and ADVERSE REACTIONS].
- Administer trimethoprim/sulfamethoxazole DS twice daily (BID) three times per week (or equivalent) as Pneumocystis jiroveci pneumonia (PCP) prophylaxis.
- Administer famciclovir 250 mg BID or equivalent as herpetic prophylaxis.
Continue PCP and herpes viral prophylaxis for a minimum of 2 months after completion of Campath or until the CD4+ count is > 200 cells/^L, whichever occurs later [see BOXED WARNING and WARNINGS AND PRECAUTIONS].
- Withhold Campath during serious infection or other serious adverse reactions until resolution.
- Discontinue Campath for autoimmune anemia or autoimmune thrombocytopenia.
- There are no dose modifications recommended for lymphopenia.
Dose Modification for Neutropenia or Thrombocytopenia [see
WARNINGS AND PRECAUTIONS]
|Hematologic Values||Dose Modification*|
|ANC < 250/μL and/or platelet count ≤ 25,000/μL|
|For first occurrence:||Withhold Campath therapy. Resume Campath at 30 mg when ANC ≥ 500/μL and platelet count ≥ 50,000/μL.|
|For second occurrence:||Withhold Campath therapy. Resume Campath at 10 mg when ANC ≥ 500/μL and platelet count ≥ 50,000/μL.|
|For third occurrence:||Discontinue Campath therapy.|
|≥ 50% decrease from baseline in patients initiating therapy with a baseline ANC ≤ 250/μL and/or a baseline platelet count ≤ 25,000/μL|
|For first occurrence:||Withhold Campath therapy. Resume Campath at 30 mg upon return to baseline value(s).|
|For second occurrence:||Withhold Campath therapy. Resume Campath at 10 mg upon return to baseline value(s).|
|For third occurrence:||Discontinue Campath therapy.|
|*If the delay between dosing is ≥ 7 days, initiate therapy at Campath 3 mg and escalate to 10 mg and then to 30 mg as tolerated [see Dosing Schedule And Administration].|
Preparation And Administration
Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. If particulate matter is present or the solution is discolored, the vial should not be used. DO NOT SHAKE VIAL.
Use aseptic technique during the preparation and administration of Campath. Withdraw the necessary amount of Campath from the vial into a syringe.
- To prepare the 3 mg dose, withdraw 0.1 mL into a 1 mL syringe calibrated in increments of 0.01 mL.
- To prepare the 10 mg dose, withdraw 0.33 mL into a 1 mL syringe calibrated in increments of 0.01 mL.
- To prepare the 30 mg dose, withdraw 1 mL in either a 1 mL or 3 mL syringe calibrated in 0.1 mL increments.
Inject syringe contents into 100 mL sterile 0.9% Sodium Chloride USP or 5% Dextrose in Water USP. Gently invert the bag to mix the solution. Discard syringe.
The vial contains no preservatives and is intended for single use only. DISCARD VIAL including any unused portion after withdrawal of dose.
Use within 8 hours after dilution. Store diluted Campath at room temperature (15-30°C) or refrigerated (2-8°C). Protect from light.
Campath is compatible with polyvinylchloride (PVC) bags and PVC or polyethylenelined PVC administration sets. Do not add or simultaneously infuse other drug substances through the same intravenous line.
Dosage Forms And Strengths
30 mg/1 mL single use vial
Storage And Handling
Campath (alemtuzumab) is supplied in single-use clear glass vials containing 30 mg of alemtuzumab in 1 mL of solution. Each carton contains three Campath vials (NDC 58468-0357-3) or one Campath vial (NDC 58468-0357-1).
Store Campath at 2-8°C (36-46°F). Do not freeze. If accidentally frozen, thaw at 2-8°C before administration. Protect from direct sunlight.
Manufactured and distributed by: Genzyme Corporation, Cambridge, MA 02142. Revised: Sep 2014
Last reviewed on RxList: 9/17/2014
This monograph has been modified to include the generic and brand name in many instances.
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