Campath

alemtuzumab

Campath

Indications

Action

Pharmacokinetics

Time/action profile (hematologic parameters)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• depression
• dizziness
• drowsiness
• fatigue
• headache
• weakness

Respiratory

• bronchospasm
• cough
• dyspnea

Cardiovascular

• hypertension
• hypotension
• tachycardia

Gastrointestinal

• abdominal pain
• anorexia
• constipation
• stomatitis

Dermatologic

• rash
• sweating

Fluid and Electrolyte

• edema

Hematologic

• neutropenia (life-threatening)
• pancytopenia/marrow hypoplasia (life-threatening)
• anemia (most frequent)
• lymphopenia (most frequent)
• thrombocytopenia (most frequent)

Musculoskeletal

• back pain
• skeletal pain

Miscellaneous

• infusion-related events (most frequent)
• infection
• sepsis

Interactions

Drug-Drug interaction

Route/Dosage

Availability

Nursing implications

Nursing 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 BP 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.
• Lab Test Considerations: 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.

Potential Nursing Diagnoses

Implementation

• high alert: Fatalities have occurred with chemotherapeutic agents. Before administering, clarify all ambiguous orders; double check single, daily, and course-of-therapy dose limits; have second practitioner independently double check original order, calculations, and infusion pump settings. Alemtuzumab should only be administered under the supervision of a physician experienced in the use antineoplastic therapy.
• Administer via IV only. Inspect solution for particulate matter or discoloration. Do not administer solutions that contain particulate matter or are discolored.

• Intravenous Administration

• pH: 6.8–7.4.
• Withdraw necessary amount from ampule into syringe. Filter with a sterile low-protein binding, non–fiber-releasing 5 micron filter prior to dilution.
• Intermittent Infusion: Diluent: Dilute with 100 mL of 0.9% NaCl or D5W. Gently invert bag to mix. Dispose of syringe and unused drug product according to institutional guidelines. Use within 8 hr of dilution. Store at room temperature or in refrigerator. Protect solution from light.
• Rate: Administer over 2 hr.
• Y-Site Incompatibility: No data is available regarding mixing with other solutions and medications. Do not add to or infuse simultaneously with other solutions or medications.

Patient/Family Teaching

• Inform patient and family of purpose of alemtuzumab.
• Caution patient to avoid immunizations with a live virus due to immunosuppression.

Evaluation/Desired Outcomes

• Improvement in hematologic parameters in patients with B-cell chronic lymphocytic leukemia.