John Libbey Eurotext

European Journal of Dermatology

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Alemtuzumab is an effective third-line treatment versus single-agent gemcitabine or pralatrexate for refractory Sézary syndrome: a systematic review Volume 28, numéro 6, November-December 2018

Illustrations

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Tableaux

Auteurs
1 Department of Dermatology,
UT Southwestern Medical Center,
Dallas,
TX, USA
2 Department of Radiation Oncology,
UT Southwestern Medical Center,
Dallas,
TX, USA
3 Department of Internal Medicine,
UT Southwestern Medical Center,
Dallas,
TX, USA
4 Department of Clinical Science,
UT Southwestern Medical Center,
Dallas,
TX, USA
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  • Mots-clés : alemtuzumab, cutaneous T-cell lymphoma, gemcitabine, mycosis fungoides, pralatrexate, Sézary syndrome
  • DOI : 10.1684/ejd.2018.3444
  • Page(s) : 764-74
  • Année de parution : 2018

The efficacy of alemtuzumab for the treatment of refractory Sézary syndrome (SS) versus other third-line agents such as pralatrexate and gemcitabine is poorly characterized. To elucidate the effectiveness of alemtuzumab versus other third-line options for the treatment of refractory SS, we conducted a meta-analysis of existing data. A systematic review was performed in March 2017 based on a search using Ovid-MEDLINE® and OVID-EMBASE® for articles evaluating single-agent alemtuzumab, gemcitabine, or pralatrexate for the treatment of SS and mycosis fungoides (MF). Twenty-two publications were identified that fulfilled all search criteria (total n = 323 patients), with six publications of lower quality being excluded from our analysis in order to decrease the risk of bias (final: n = 308 patients; 93 with SS and 147 with MF). Across all studies, alemtuzumab was significantly more effective in patients with SS (overall response rate [ORR]: 81%; complete response rate [CRR]: 38%) than patients with MF (ORR: 29%; CRR: 8%). However, gemcitabine was more effective than alemtuzumab or pralatrexate in treating MF. Alemtuzumab-treated patients had more frequent side effects, which were influenced by route of administration and dose. There was a lower incidence of lymphopenia and other serious adverse events in patients treated with subcutaneous (38%) compared to intravenous regimens (68%), and lower-dose (5%) compared to high-dose alemtuzumab regimens (54%). No significant differences were found in the effectiveness of different routes of administration or dosing regimens. Our review supports the use of low-dose subcutaneous alemtuzumab as a third-line treatment for SS.