“The proof is in the eating of the pudding, we have had several male MSers who have been treated with alemtuzumab who have gone onto have children who are healthy and well. I would urge you to wait until more detailed data on this issue is presented at ECTRIMS. I promise to post the results as soon as I can. In my opinion the sperm issue is a non-issue.”
“The second study below is simply a hypothesis paper suggesting that scientists target CD52, and related proteins, on sperm as an immunological target for a male contraceptive. This idea is barmy; simply because CD52 is present on all white cells and if the immune, or vaccine, strategy worked then all male recipients who received it are likely to develop a severe leukopenia (low white cell count) as the antibodies would also target white cells and put them at risk of infections. Who would sign-up for a study for a contraceptive vaccine with the potential to cause a leukopenia? The other reason why it is barmy is that if you induce an immune response against your sperm, or testes, to lower the sperm count you may not be able to reverse it and hence you will be left with permanent infertility. The principle behind contraception is reversible infertility not permanent infertility.”
“The final paper that refers to infertility in male bone marrow recipients. In this context alemtuzumab is usually given in conjunction with other conditioning treatments that damage the testes. This study is important and demonstrates why you simply can’t extrapolate what is in the oncology, or transplant, literature to the field of MS. I have noted that a lot of readers have been reading about the safety profile and side effects of alemtuzumab in leukemia and assuming that this is the profile in MS. It is not. Firstly, the leukaemia patients are much older and much sicker than MSers; in other words they have lots of other problems that puts them at risk of infections and complications of treatment. Secondly, the dose of alemtuzumab that is used to treat leukemia is much larger than the doses used to treat MS. Leukaemia patients get over 1,000mg in a year compared to 60mg in year and 36mg in year 2 for MSers. Thirdly, leukemia patients tend to have a high cell or tumor burden that puts them at risk of cell lysis syndrome. Alemtuzumab works like a heat-seeking missile and binds to CD52 on the surface of white blood or leukemia cell, it then activates other proteins in the blood that punch a hole in the cell causing it to release its contents and die. As cells burst they release their active molecules that are responsible for the infusion reactions. The more cells that burst the more active molecules are released the greater the infusion reaction. When this occurs in leukemia patients the number of cells bursting is much larger than what occurs in MS hence the occurrence of serious and life threatening infusion reactions are almost exclusive to the leukemia population.”
“My advice to readers of this blog is not to read about any of the side effects that occur in alemtuzumab-treated leukemia, cancer and transplant patients, they are simply not relevant to MS. You need to focus on what happens in MSers who receive this drug; the side effect profile in MSers is very different and manageable.”
Focarelli et al. A sialoglycoprotein, gp20, of the human capacitated sperm surface is a homologue of the leucocyte CD52 antigen: analysis of the effect of anti-CD52 monoclonal antibody (CAMPATH-1) on capacitated spermatozoa. Mol Hum Reprod. 1999;5(1):46-51.
Background: There are concerns that alemtuzumab may affect sperm function.
Kyriacou et al. Germ cell damage and Leydig cell insufficiency in recipients of nonmyeloablative transplantation for haematological malignancies..Bone Marrow Transplant. 2003 Jan;31(1):45-50.
Background: Most bone marrow transplant recipients are infertile due to reversible or irreversible testicular failure. However, little is known about the gonadotoxic potential of the newly introduced nonmyeloablative transplants.