Premium
Long remissions in hairy cell leukemia with purine analogs
Author(s) -
Else Monica,
Ruchlemer Rosa,
Osuji Nnenna,
Del Giudice Ilaria,
Matutes Estella,
Woodman Anthony,
Wotherspoon Andrew,
Swansbury John,
Dearden Claire,
Catovsky Daniel
Publication year - 2005
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.21447
Subject(s) - pentostatin , cladribine , medicine , hairy cell leukemia , purine analogue , oncology , gastroenterology , complete response , leukemia , purine , chemotherapy , lymphoma , rituximab , biochemistry , chemistry , enzyme
BACKGROUND Both pentostatin and cladribine have efficacy in hairy cell leukemia (HCL), but it is not known which agent achieves better results. METHODS We reviewed a series of 219 patients with HCL, with median follow‐up from diagnosis of 12.5 years (range 1.0 –34.6 yrs), treated with either pentostatin ( n = 185) or cladribine ( n = 34), to compare these agents and assess the potential for cure. RESULTS Overall response to pentostatin was 96% with a complete response (CR) in 81% and a median disease‐free survival (DFS) of 15 years. Response to first‐line cladribine was 100% with a CR in 82% and DFS of 11+ years. The relapse rates at 5 years and 10 years were 24% and 42%, respectively, with pentostatin, and 33% and 48% with cladribine. Survival at 10 years was respectively 96% and 100%. CR rates decreased with each sequential relapse through 69% to 45% ( P ≤ 0.001). Patients achieving CR after first‐line treatment had a significantly longer DFS ( P = 0.00007) than those achieving a partial response; a similar result was seen after second‐line therapy ( P = 0.00001). DFS also declined with sequential treatment ( P = 0.00005). CONCLUSION We have shown equivalent efficacies for both agents in the treatment of HCL, with DFS showing no plateau. True cure in HCL remains elusive, but the addition of monoclonal antibodies may be beneficial. Our results suggest that achieving CR should remain the main goal of treatment. Cancer 2005. © 2005 American Cancer Society.