Dosing and Administration

Recommended concomitant medications

Diphenhydramine 50 mg and acetaminophen 650 mg 30 minutes before first infusion, at dose escalations, and thereafter as needed

Trimethoprim/sulfamethoxazole DS twice daily 3 times weekly and famciclovir (or equivalent) 250 mg bid upon start of therapy and continuing until 2 months after therapy or until CD4+ count is >200 cells/µL, whichever occurs later

Campath^® (alemtuzumab) should be discontinued during serious infection, serious hematologic toxicity, or other serious toxicity until the event resolves

Do not administer as IV push or bolus
Do not administer single doses >30 mg or cumulative weekly doses >90 mg, since higher doses increase risk of pancytopenia
Campath therapy should be initiated at a dose of 3 mg administered as a 2-hour IV infusion daily
Dose escalation to the recommended maintenance dose of 30 mg administered 3 times per week is required
In cases where severe infusion-related events occur, treatment with hydrocortisone 200 mg was used in decreasing the infusion-related events
Campath therapy should be permanently discontinued if evidence of autoimmune anemia or thrombocytopenia appears. (See table below for recommendations for dose modification for severe neutropenia or thrombocytopenia)

Hematologic Toxicity	Dose Modification and Reinitiation of Therapy
For first occurrence of ANC <250/µL and/or platelet count ≤25,000/µL	Withhold Campath therapy. When ANC ≥500/µL and platelet count ≥50,000/µL, resume Campath therapy at same dose. If delay between dosing is ≥7 days, initiate therapy at Campath 3 mg and escalate to 10 mg and then to 30 mg as tolerated.
For second occurrence of ANC <250/µL and/or platelet count ≤25,000/µL	Withhold Campath therapy. When ANC ≥500/µL and platelet count ≥50,000/µL, resume Campath therapy at 10 mg. If delay between dosing is ≥7 days, initiate therapy at Campath 3 mg and escalate to 10 mg only.
For third occurrence of ANC <250/µL and/or platelet count ≤25,000/µL	Discontinue Campath therapy permanently.
For a decrease of ANC and/or platelet count to ≤50% of the baseline value in patients initiating therapy with a baseline ANC ≤500/µL and/or a baseline platelet count ≤25,000/µL	Withhold Campath therapy. When ANC and/or platelet count return to baseline value(s), resume 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.