Charlotte Pither¹, Stephen Middleton¹, Peter Friend², Anil Vaidya², Beate Mengelkoch¹, Neville Jamieson¹, Chris Callaghan¹, Jeremy Woodward¹, Christopher Watson¹, Rajesh Sivapraksam¹, Andrew Butler¹

¹Gastroenterology and Transplantation Departments, Addenbrookes, Cambridge University Hospital NHS Foundation Trust , Cambridge, United Kingdom; ²Oxford Transplant Centre, Churchill Hospital, Oxford, United Kingdom

Introduction: The intravenous administration of alemtuzumab has been used successfully for the treatment of rheumatological conditions, in some haematological malignancies and in organ transplantation as an induction agent to achieve rapid and sustained depletion of circulating T and B lymphocytes. Administration by the intravenous route is usual; however cardiac complications such as supra-ventricular tachycardia are documented to occur in approximately 11%.

Alemtuzumab can be administered subcutaneously, this route has been used in Cambridge for patients undergoing induction therapy for small bowel and multivisceral grafts for 6 years. We compare our side effect profile and adequacy of lymphocyte depletion with another UK centre, Oxford who routinely administer the drug intravenously.

Methods: Review of the medical records to establish a) Lymphocyte counts of patients receiving small bowel/multivisceral grafts in Cambridge and Oxford b) Frequency of serious cardiac or life threatening events believed to be related to the administration of alemtuzumab.

Results: Levels of lymphocyte depletion were adequate in patients from both centres.

None of the patients receiving a graft in either the Cambridge (n=15 transplants) or Oxford (n=9 transplants) group experienced any severe or life threatening side effects.

Discussion: Previous studies indicate that subcutaneous administration of alemtuzumab is associated with fewer serious complications probably due to slower rates of absorption. This study confirms those findings and additionally suggests that lymphocyte depletion is not compromised by the subcutaneous route.

Conclusion: Alemtuzumab given subcutaneously after small intestinal and multivisceral grafts seems to achieve appropriate lymphocyte depletion, and is likely to have better side effect profile although these findings need to be confirmed with a larger number of patients.