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The role of rituximab in combination with pentostatin or cladribine for the treatment of recurrent/refractory hairy cell leukemia Else M; Osuji N; Forconi F; Dearden C; Del Giudice I; Matutes E; Wotherspoon A; Lauria F; Catovsky DCancer 2007[Nov]; 110 (10): 2240-7BACKGROUND: The purine analogs pentostatin and cladribine have revolutionized the treatment of hairy cell leukemia (HCL) with overall responses in greater than 85% of patients and a median progression-free survival of up to 15 years. They continue to be effective at second- and even third-line therapy; however, alternative treatments are needed for patients who are or have become refractory to these agents or whose remissions are shorter with each course of therapy. METHODS: The authors conducted a retrospective review of 8 patients who received pentostatin or cladribine combined concurrently (n = 6 patients) or sequentially (n = 2 patients) with rituximab at second-line therapy (n = 3 patients) and at subsequent lines of therapy (n = 5 patients). Results from a previously reported database of 219 patients with HCL (73 patients who received second-line therapy and 20 patients who received third-line therapy) were used as a historic control group against which to measure benefit. RESULTS: All 8 patients responded to therapy, with 7 complete responses (CRs) (87.5%) and minimal toxicity. All patients who had CRs were negative for minimal residual disease (MRD). At a median follow-up of 29 months (range, 5-39 months) 1 patient developed recurrent disease, and the estimated 2-year recurrence rate was 20% (0% after second-line therapy and 25% after subsequent lines of therapy). In the historic control group, the CR rates were 70% after second-line therapy and 45% after third-line therapy, and the recurrence rates at 2 years were 15% and 33%, respectively. CONCLUSIONS: The combination of purine analogs with rituximab was safe and effective for patients with recurrent and/or refractory HCL, and the current results suggested an added benefit compared with standard treatment.|Adult[MESH]|Aged[MESH]|Antibodies, Monoclonal, Murine-Derived[MESH]|Antibodies, Monoclonal/administration & dosage[MESH]|Antineoplastic Combined Chemotherapy Protocols/administration & dosage/*therapeutic use[MESH]|Cladribine/administration & dosage[MESH]|Female[MESH]|Humans[MESH]|Leukemia, Hairy Cell/*drug therapy[MESH]|Male[MESH]|Middle Aged[MESH]|Pentostatin/administration & dosage[MESH]|Recurrence[MESH]|Rituximab[MESH] |
