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2-chlorodeoxyadenosine induces durable remissions and prolonged suppression
of CD4+ lymphocyte counts in patients with hairy cell leukemia
JF Seymour, R Kurzrock, EJ Freireich and EH Estey
Department of Hematology, University of Texas, M.D. Anderson Cancer Center,
Houston.
A number of effective treatments are available for patients with hairy cell
leukemia (HCL). 2-Chlorodeoxyadenosine (2-CdA) induces more than 80%
complete responses, but is associated with profound suppression of CD4+
lymphocyte counts. However, the duration of each is uncertain. We have
analyzed a previously reported cohort of 40 patients who had responded to
2-CdA. Eight patients (20%) have relapsed at a median of 16 months (range,
3 to 23 months). The remaining 32 patients were observed for a median of 30
months (range, 7 to 43 months). No patients have died. At 3 years, the
actuarial disease-free survival rate is 77% (95% confidence interval, 70%
to 84%). The median CD4+ lymphocyte count before therapy was 743/microL
(range, 58 to 2,201/microL). The median CD4+ nadir after treatment was
139/microL (range, 25 to 580/microL). There was a single opportunistic
infection and no second malignancies observed. Although there was evidence
of some improvement in CD4+ lymphocyte counts on sequential testing, CD4+
counts remained significantly lower than baseline (P < .0001) at a
median of 23 months after therapy (median, 237/microL; range, 25 to
514/microL), and were also lower than baseline (P < .002) in those
patients with more than 1 year of follow-up (median, 27 months; range, 13
to 42 months). The median time to reach an absolute CD4+ lymphocyte count
of 365/microL, the lower limit of the normal range, was 40 months. Although
responses to 2-CdA are durable in the majority of patients with HCL, the
uncertain long-term consequences of the observed CD4+ lymphocytopenia
suggest caution in the broad application of this therapy.
Volume 83,
Issue 10,
pp. 2906-2911,
05/15/1994
Copyright © 1994 by The American Society of Hematology
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