Alemtuzumab Highly Effective in CTCL Without Papular History: Analysis
Key Takeaways
Cutaneous T-cell lymphoma (CTCL) patients with a pure memory T-cell clinical (TRM) phenotype had significantly higher global and skin resolution rates following LDA therapy.
Absence of papules, plagues, and tumors (PPT) at time of treatment initiation predicted stronger response.
Low dose alemtuzumab was well-tolerated with a low rate of serious infections, and pruritus improved in most patients.
A new analysis suggests the absence of papules, plaques, and tumors (PPT) in cutaneous T-cell lymphoma (CTCL) may predict favorable clinical outcomes with low dose alemtuzumab (LDA) therapy.
In a retrospective cohort study of 38 patients treated at Dana-Farber/Harvard Cancer Center, those without PPT achieved significantly higher global and skin complete response (CR) rates following LDA compared to those with a history of PPT, a feature associated with skin-resident memory T-cell (TRM) phenotype.
The retrospective cohort study included 38 patients who all received subcutaneous alemtuzumab 10 mg three times weekly. Eleven patients (29%) were classified as having a TCM phenotype and 27 were categorized as TRM or migratory memory T-cell (TMM) phenotypes.
Overall, 65.8% of patients responded to LDA, but TCM phenotype patients were more than eight times as likely to achieve a global complete response compared to those with a history of PPT (OR = 8.2; 95% CI: 1.2 to 57.6). In the skin, comlete resolution was achieved in 81.8% of TCM patients vs. 37.0% in TRM/TMM patients (OR = 7.7; 95% CI: 1.4 to 42.7). In patients with active PPT at treatment initiation, the skin complete resolution rate fell to 17.7%.
Multivariable regression analysis identified a history of PPT, baseline lactase dehydrogenase (LDH) levels, and time from diagnosis to LDA initiation as predictors of complete resolution. Time to itch cessation was also faster among TCM phenotype patients (all reported resolution by 3.4 months). Pruritus relief was associated with both absence of PPT. The five-year cumulative incidence of death did not differ significantly between TCM and non-TCM groups (47% overall).
"Our study supports the use of LDA in the treatment of CTCL with blood involvement, particularly in patients with the appropriate clinical phenotype – those presenting with blanching erythema and no active or prior palpable disease – the TRM phenotype. To our knowledge, this is the largest cohort of CTCL patients treated with LDA with a minimum of 5 years of clinical follow-up."
Source: Kim EJ, Geskin LJ, et al. Blood Cancer Journal. 2025. doi:10.1038/s41408-025-01237-5