Long remissions in hairy cell leukemia with purine analogs

A report of 219 patients with a median follow-up of 12.5 years

Authors

  • Monica Else M.A., M.Sc.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Rosa Ruchlemer M.D.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Nnenna Osuji M.B.Ch.B., M.Sc.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Ilaria Del Giudice M.D.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Estella Matutes M.D., Ph.D.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Anthony Woodman M.Sc., Ph.D.,

    1. BioMedical Centre, Cranfield University, Silsoe, United Kingdom
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  • Andrew Wotherspoon M.B., B.Ch.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • John Swansbury,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Claire Dearden M.B., M.D.,

    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
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  • Daniel Catovsky M.D., D.Sc.

    Corresponding author
    1. Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom
    • Section of Haemato-Oncology, Brookes Lawley Building, Institute of Cancer Research, Cotswold Road, Sutton, Surrey SM2 5NG, UK
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    • Fax: (011) 44 0 20 8722 4266


Abstract

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.

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