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Long remissions in hairy cell leukemia with purine analogs
A report of 219 patients with a median follow-up of 12.5 years
Article first published online: 21 OCT 2005
Copyright © 2005 American Cancer Society
Volume 104, Issue 11, pages 2442–2448, 1 December 2005
How to Cite
Else, M., Ruchlemer, R., Osuji, N., Del Giudice, I., Matutes, E., Woodman, A., Wotherspoon, A., Swansbury, J., Dearden, C. and Catovsky, D. (2005), Long remissions in hairy cell leukemia with purine analogs. Cancer, 104: 2442–2448. doi: 10.1002/cncr.21447
- Issue published online: 18 NOV 2005
- Article first published online: 21 OCT 2005
- Manuscript Accepted: 30 JUN 2005
- Manuscript Revised: 11 JUN 2005
- Manuscript Received: 12 MAY 2005
- Barclay Family Cancer Research Foundation scholarship
- Arbib Foundation
- British Society of Haematology fellowship
- hairy cell leukemia;
Both pentostatin and cladribine have efficacy in hairy cell leukemia (HCL), but it is not known which agent achieves better results.
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.
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).
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.