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Blood, Vol. 92 No. 6 (September 15), 1998:
pp. 1918-1926
Long-Term Follow-Up of Patients With Hairy Cell Leukemia After
Cladribine Treatment
Alan Saven,
Carol Burian,
James A. Koziol, and
Lawrence D. Piro
From the Division of Hematology/Oncology, Ida M. and Cecil H. Green
Cancer Center, Scripps Clinic, La Jolla, CA; The Scripps Research
Institute, La Jolla, CA; and the Division of Hematology/Oncology,
Cedars-Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA.
Hairy cell leukemia is a chronic B-cell disorder that follows an
indolent, but progressive course. Cladribine (2-chlorodeoxyadenosine) induces complete remissions in the majority of patients after a single
course. We report the long-term outcomes, including response rates and
their duration; time-to-treatment failure (TTF) rates; retreatment
results; toxicities; and survival rates of patients treated at Scripps
Clinic (La Jolla, CA). A total of 358 patients with hairy cell leukemia
were treated with cladribine at 0.087 or 0.1 mg/kg body weight per day
by continuous intravenous infusion for 7 days. The expected number of
second neoplasms was based on the National Cancer Institute's
Surveillance Epidemiology and End Results data. Of 349 evaluable
patients, 319 (91%) achieved an initial complete response and 22 (7%)
a partial response with an overall median duration of response
follow-up of 52 months. Ninety patients (26%) had relapsed at a median
of 29 months. The TTF rate for all 341 responders was 19% at 48 months, 16% for complete responders, and 54% for partial responders.
Of 53 evaluable patients treated with second courses of cladribine at
first relapse, 33 (62%) achieved complete responses and 14 (26%)
partial responses. Twenty-seven patients (8%) developed second
neoplasms (only 1 hematopoietic) with an observed-to-expected ratio of
1.88 (95% confidence interval, 1.24 to 2.74). The overall survival
rate was 96% at 48 months. Single courses of cladribine induced
long-lasting complete responses in the vast majority of patients.
Relapse rates for complete responders were low. Patients who relapse
can be successfully retreated with cladribine. Cladribine has high
efficacy and a favorable acute and long-term toxicity profile when
administered to patients with hairy cell leukemia.
© 1998 by The American Society of Hematology.
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