Journal of Clinical Oncology, Vol 15, 1138-1142, Copyright © 1997 by American Society of Clinical Oncology
Treatment of hairy-cell leukemia with cladribine: response, toxicity, and long-term follow-up
MA Hoffman, D Janson, E Rose and KR Rai
Department of Medicine, Long Island Jewish Medical Center campus of the Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA. hoffman@lij.edu
PURPOSE: To analyze initial and long-term outcomes after treatment of
patients with active hairy-cell leukemia (HCL) with a single cycle of
cladribine (2-CdA). PATIENTS AND METHODS: Forty-nine patients with active
HCL were treated with 2-CdA by continuous intravenous infusion at 0.1
mg/kg/d for a total of 7 days at the Long Island Jewish Medical Center
between September 1990 and August 1992. Here we report on all patients
followed-up until April 1996. RESULTS: At 3 months after treatment,
complete response (CR) occurred in 37 patients (76%) and partial response
(PR) occurred in 12 patients (24%), for an overall response rate of 100%
(95% confidence interval, 94% to 100%). At a median follow-up of 55 months,
the relapse-free survival is 80% and overall survival is 95%. Ten patients
(20%) have relapsed. Of the 26 patients in whom lymphocyte phenotyping was
performed, four were found to have a CD25-negative phenotype. All four of
these patients had PRs only and all relapsed. Eight patients have been
re-treated with 2-CdA, and all achieved at least a partial remission; two
of these have already relapsed with remission durations of less than 1
year. Five second malignancies have occurred in four patients. CONCLUSION:
With a median follow-up of more than 4 years, 39 patients (80%) continue in
remission. Only two deaths have occurred. A CD25-negative phenotype may
predict for a poorer response to 2-CdA. Patients who relapse may be re-
treated with 2-CdA, but subsequent remissions may be of shorter duration.
There has not been a markedly increased incidence of second malignancies or
late opportunistic infections.
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