Table 2: Overview of the Infectious Complications of Alemtuzumab

  Risk Impact on Prophylaxis Impact on Laboratory Monitoring
Bacterial Infections No increased risk including Streptococcus, Listeria, Nocardia or MAC (common pathogens in AIDS)  (49, 57) None Aggressive microbiologic evaluation for febrile transplant recipients who have received ATG
BK Virus   Increased risk as compared to IL-2R antagonists or no induction  (17) but similar to ATG (23) N/A Consider more frequent screening (monthly rather than quarterly)
CMV   Increased risk as compared to IL-2R antagonists (48) but likely similar to ATG Consider extended prophylaxis to 6 months, especially in D+/R-.  Failure of prophylaxis has been reported Consider either prolonged preemptive protocols or screening for reactivation after completion of prophylaxis
EBV / PTLD   Likely increased risk but data is mixed and long term data lacking None EBV donor + /recipient – patients should be screened for EBV infection
Fungal Infections No increased risk when used for induction, significant increased risk when used for rejection.  If exposure to endemic fungi, prophylaxis for 6-12 months is indicated If exposure to endemic fungus, routine screening likely indicated
HSV/HZV Increased Adequately covered by CMV prophylaxis or acyclovir derivatives if not on CMV prophylaxis None
HCV/HBV   No benefit over conventional induction treatment for liver transplant with potential for increased complications including systemic infection (31) N/A for HCV, Follow standard protocols for HBV prophylaxis Consider routine viral load monitoring in known to have positive viremia. 


Consider monitoring for reactivation of viremia in recipients with negative viral loads prior to transplant
Pneumocystis Prolonged risk due to T-cell depletion Minimum of 6-12 months of prophylaxis, consider more prolonged prophylaxis in heart and/or lung recipients None