Consolidation therapy with alemtuzumab prolongs remission of chronic lymphocytic leukaemia

The use of chemotherapeutic agents such as fludarabine has made it possible to treat chronic lymphocytic leukemia (CLL) more effectively than was previously possible with alkylating agents. However, relapse still occurs frequently as the disease can re-emerge from remnants of the malignant cell clone – referred to as minimal residual disease (MRD). Thus, the primary goal of consolidation therapy in CLL is to eradicate MRD and thereby alter the treatment goal from palliation to cure. Consolidation therapy with alemtuzumab following fludarabine or fludarabine-based chemotherapy can provide an improvement in the quality of clinical responses, an increase in progression-free survival, eradication of MRD, and molecular remission in more than one-third of patients with CLL. A treatment interval of 3 to 6 months between induction chemotherapy and alemtuzumab consolidation appears to minimize the risk of infectious complications. Ongoing trials will need to answer remaining issues regarding timing, schedule and dose of alemtuzumab consolidation therapy. Although alemtuzumab consolidation is not yet a treatment standard in CLL, this approach might bring us closer to the treatment goal of cure in CLL.