"The U.S. Food and Drug Administration today approved Gazyva (obinutuzumab) for use in combination with chlorambucil to treat patients with previously untreated chronic lymphocytic leukemia (CLL).
CLL is a blood and bone ma"...
Campath Side Effects Center
Medical Editor: John P. Cunha, DO, FACOEP
Campath (alemtuzumab) is used to treat chronic lymphocytic leukemia. It is usually given after other medications have been tried without successful treatment. Campath is an antibody made from animal DNA. Common side effects include fever, chills, dizziness, muscle stiffness, nausea, vomiting, headache, diarrhea, mild rash/itching, tiredness, or trouble breathing during or after the infusion. These reactions occur more often during the first week of treatment.
Campath medication is given intravenously under physician supervision, usually over 2 hours. Dosage is based on the patient's response to treatment. Patients are usually started on a low dose of the medication, and the dose may be slowly increased. Other drugs may affect Campath. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. During pregnancy, Campath should be used only when prescribed. It is recommended that men and women receiving this medication use at least 2 forms of birth control (e.g., condoms, birth control pills) during treatment with this medication and for at least 6 months afterwards. It is not known whether this drug passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this drug is not recommended during treatment with this medication and for at least 3 months afterwards.
Our Campath (alemtuzumab) Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
What is Patient Information in Detail?
Easy-to-read and understand detailed drug information and pill images for the patient or caregiver from Cerner Multum.
Campath in Detail - Patient Information: Side Effects
Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.
Some people receiving a alemtuzumab injection have had a reaction to the infusion (when the medicine is injected into the vein). Tell your caregiver right away if you feel dizzy, hot or cold, nauseated, light-headed, sweaty, itchy, or have a fast heartbeat, chest tightness, or trouble breathing during the injection.
Call your doctor at once if you have any of these serious side effects:
- pale skin, easy bruising or bleeding, unusual weakness;
- chest pain or heavy feeling, pain spreading to the arm or shoulder, nausea, sweating, general ill feeling;
- fever, chills, body aches, flu symptoms;
- feeling light-headed, fainting;
- confusion, hallucinations; or
- white patches or sores inside your mouth or on your lips.
Less serious side effects include:
- nausea, vomiting, stomach pain;
- diarrhea, constipation;
- loss of appetite;
- back or chest pain;
- sleep problems (insomnia);
- tired feeling;
- runny nose, sore throat; or
- sweating, mild skin rash or itching;
Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.
Read the entire detailed patient monograph for Campath (Alemtuzumab) »
What is Patient Information Overview?
A concise overview of the drug for the patient or caregiver from First DataBank.
Campath Overview - Patient Information: Side Effects
Fever, chills, dizziness, muscle stiffness, nausea, vomiting, headache, diarrhea, mild rash/itching, tiredness, or trouble breathing may occur during or after the infusion. These reactions occur more often during the first week of treatment. Tell your doctor or pharmacist immediately if any of these effects occur, persist, or worsen. Your doctor may prescribe additional medications to help control these symptoms. Mouth sores, loss of appetite, shaking (tremor), stomach/abdominal pain, constipation, drowsiness, cough, increased sweating, or trouble sleeping may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.
Many people using this medication have serious side effects. However, your doctor has prescribed this drug because he or she has judged that the benefit to you is greater than the risk of side effects. Careful monitoring by your doctor may decrease your risk.
Tell your doctor immediately if any of these serious side effects occur: shortness of breath, mental/mood changes (e.g., depression, anxiety), bone pain, muscle pain/spasm, unusual weakness, swelling ankles/feet, yellowing skin/eyes, change in the amount of urine, painful urination, numbness/tingling of arms/legs, pain/redness/swelling of arms/legs/injection site.
Seek immediate medical attention if any of these rare but very serious side effects occur: fainting, trouble breathing, chest/jaw/left arm pain, irregular heartbeat, seizures, confusion, vision changes, weakness on one side of the body.
A very serious allergic reaction to this drug is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.
This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.
In the US -
Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.
In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.
Read the entire patient information overview for Campath (Alemtuzumab)»
What is Prescribing information?
The FDA package insert formatted in easy-to-find categories for health professionals and clinicians.
Campath FDA Prescribing Information: Side Effects
The following adverse reactions are discussed in greater detail in other sections of the label:
- Cytopenias [see WARNINGS AND PRECAUTIONS ]
- Infusion Reactions [see WARNINGS AND PRECAUTIONS]
- Immunosuppression/Infections [see WARNINGS AND PRECAUTIONS]
The most common adverse reactions with Campath (alemtuzumab) are: infusion reactions (pyrexia, chills, hypotension, urticaria, nausea, rash, tachycardia, dyspnea), cytopenias (neutropenia, lymphopenia, thrombocytopenia, anemia), infections (CMV viremia, CMV infection, other infections), gastrointestinal symptoms (nausea, emesis, abdominal pain), and neurological symptoms (insomnia, anxiety). The most common serious adverse reactions are cytopenias, infusion reactions, and immunosuppression/infections.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
The data below reflect exposure to Campath (alemtuzumab) in 296 patients with CLL of whom 147 were previously untreated and 149 received at least 2 prior chemotherapy regimens. The median duration of exposure was 11.7 weeks for previously untreated patients and 8 weeks for previously treated patients.
Lymphopenia: Severe lymphopenia and a rapid and sustained decrease in lymphocyte subsets occurred in previously untreated and previously treated patients following administration of Campath (alemtuzumab) . In previously untreated patients, the median CD4+ was 0 cells/µL at one month after treatment and 238 cells/µL [25-75% interquartile range 115 to 418 cells/µL at 6 months post-treatment [see WARNINGS AND PRECAUTIONS].
Neutropenia: In previously untreated patients, the incidence of Grade 3 or 4 neutropenia was 42% with a median time to onset of 31 days and a median duration of 37 days. In previously treated patients, the incidence of Grade 3 or 4 neutropenia was 64% with a median duration of 28 days. Ten percent of previously untreated patients and 17% of previously treated patients received granulocyte colony stimulating factors.
Anemia: In previously untreated patients, the incidence of Grade 3 or 4 anemia was 12% with a median time to onset of 31 days and a median duration of 8 days. In previously treated patients, the incidence of Grade 3 or 4 anemia was 38%. Seventeen percent of previously untreated patients and 66% of previously treated patients received either erythropoiesis stimulating agents, transfusions or both.
Thrombocytopenia: In previously untreated patients, the incidence of Grade 3 or 4 thrombocytopenia was 14% with a median time to onset of 9 days and a median duration of 14 days. In previously treated patients, the incidence of Grade 3 or 4 thrombocytopenia was 52% with a median duration of 21 days. Autoimmune thrombocytopenia was reported in 2% of previously treated patients with one fatality.
Infusion reactions: Infusion reactions, which included pyrexia, chills, hypotension, urticaria, and dyspnea, were common. Grade 3 and 4 pyrexia and/or chills occurred in approximately 10% of previously untreated patients and in approximately 3 5% of previously treated patients. The occurrence of infusion reactions was greatest during the initial week of treatment and decreased with subsequent doses of Campath (alemtuzumab) . All patients were pretreated with antipyretics and antihistamines; additionally, 43% of previously untreated patients received glucocorticoid pre-treatment.
Infections: In the study of previously untreated patients, patients were tested weekly for CMV using a PCR assay from initiation through completion of therapy, and every 2 weeks for the first 2 months following therapy. CMV infection occurred in 16% (23/147) of previously untreated patients; approximately one-third of these infections were serious or life threatening. In studies of previously treated patients in which routine CMV surveillance was not required, CMV infection was documented in 6% (9/149) of patients; nearly all of these infections were serious or life threatening.
Other infections were reported in approximately 50% of patients across all studies. Grade 3-5 sepsis ranged from 3% to 10% across studies and was higher in previously treated patients. Grade 3 - 4 febrile neutropenia ranged from 5 to 10% across studies and was higher in previously treated patients. Infection-related fatalities occurred in 2% of previously untreated patients and 16% of previously treated patients. There were 198 episodes of other infection in 109 previously untreated patients; 16% were bacterial, 7% were fungal, 4% were other viral, and in 73%, the organism was not identified.
Cardiac: Cardiac dysrhythmias occurred in approximately 14% of previously untreated patients. The majority were tachycardias and were temporally associated with infusion; dysrhythmias were Grade 3 or 4 in 1% of patients.
Previously Untreated Patients
Table 1 contains selected adverse reactions observed in 294 patients randomized (1:1) to receive Campath (alemtuzumab) or chlorambucil as first line therapy for B-CLL. Campath (alemtuzumab) was administered at a dose of 30 mg intravenously three times weekly for up to 12 weeks. The median duration of therapy was 11.7 weeks with a median weekly dose of 82 mg (25-75% interquartile range: 69 mg - 90 mg).
|Per Patient Incidence of Selected1 Adverse Reactions in Treatment Naive B-CLL Patients|
|Campath (n=147)||Chlorambucil (n=147)|
| All Grades
| Grades 3-4
|Blood and Lymphatic System Disorders||Lymphopenia||97||97||9||1|
|General Disorders and Administration Site Conditions||Pyrexia||69||10||11||1|
|Infections and Infestations||CMV viremia3||55||4||8||0|
|Skin and Subcutaneous Tissue Disorders||Urticaria||16||2||1||0|
|Nervous System Disorders||Headache||14||1||8||0|
|Respiratory, Thoracic and Mediastinal Disorders||Dyspnea||14||4||7||3|
| 1Adverse reactions occurring
at a higher relative frequency in the Campath (alemtuzumab) arm
2NCI CTC version 2.0 for adverse reactions; NCI CTCAE version 3.0 for laboratory values
3CMV viremia (without evidence of symptoms) includes both cases of single PCR positive test results and ofconfirmed CMV viremia ( ≥ 2 occasions in consecutive samples 1 week apart). For the latter, ganciclovir (orequivalent) was initiated per protocol.
Previously Treated Patients
Additional safety information was obtained from 3 single arm studies of 149 previously treated patients with CLL administered 30 mg Campath (alemtuzumab) intravenously three times weekly for 4 to 12 weeks (median cumulative dose 673 mg [range 2 - 1106 mg]; median duration of therapy 8.0 weeks). Adverse reactions in these studies not listed in Table 1 that occurred at an incidence rate of > 5% were fatigue, nausea, emesis, musculoskeletal pain, anorexia, dysesthesia, mucositis, and bronchospasm.
As with all therapeutic proteins, there is potential for immunogenicity. Using an ELIS A assay, anti-human antibodies (HAHA) were detected in 11 of 133 (8.3%) previously untreated patients. In addition, two patients were weakly positive for neutralizing activity. Limited data suggest that the anti-Campath (alemtuzumab) antibodies did not adversely affect tumor response. Four of 211 (1.9%) previously-treated patients were found to have antibodies to Campath (alemtuzumab) following treatment.
The incidence of antibody formation is highly dependent on the sensitivity and specificity of the assay. Additionally, the observed incidence of antibody (including neutralizing antibody) positivity in an assay may be influenced by several factors including assay methodology, sample handling, timing of sample collection, concomitant medications, and underlying disease. For these reasons, comparison of the incidence of antibodies to Campath (alemtuzumab) with the incidence of antibodies to other products may be misleading.
The following adverse reactions were identified during post-approval use of Campath (alemtuzumab) . Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to Campath (alemtuzumab) exposure. Decisions to include these reactions in labeling are typically based on one or more of the following factors: (1) seriousness of the reaction, (2) reported frequency of the reaction, or (3) strength of causal connection to Campath (alemtuzumab) .
Fatal infusion reactions: [see WARNINGS AND PRECAUTIONS].
Immune disorders: Goodpasture's syndrome, Graves' disease, aplastic anemia, Guillain Barre syndrome, chronic inflammatory demyelinating polyradiculoneuropathy, serum sickness.
Metabolic: Tumor lysis syndrome
Neurologic: Optic neuropathy
Read the entire FDA prescribing information for Campath (Alemtuzumab) »
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