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Blood, 15 June 2006, Vol. 107, No. 12, pp. 4658-4662.
Prepublished online as a Blood First Edition Paper on February 23, 2006; DOI 10.1182/blood-2005-11-4590.


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CLINICAL TRIALS AND OBSERVATIONS

Eradication of minimal residual disease in hairy cell leukemia

Farhad Ravandi, Jeffrey L. Jorgensen, Susan M. O'Brien, Srdan Verstovsek, Charles A. Koller, Stefan Faderl, Francis J. Giles, Alessandra Ferrajoli, William G. Wierda, Shirley Odinga, Xuelin Huang, Deborah A. Thomas, Emil J. Freireich, Dan Jones, Michael J. Keating, and Hagop M. Kantarjian

From the Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, Houston, TX; the Department of Hematopathology, University of Texas, M.D. Anderson Cancer Center, Houston, TX; and the Department of Biostatistics, University of Texas, M.D. Anderson Cancer Center, Houston, TX.

Although the nucleoside analogs cladribine and pentostatin produce high response rates in patients with hairy cell leukemia (HCL), a significant number of patients eventually relapse. Several studies have demonstrated that patients with complete remission (CR) have a longer disease-free survival. Therefore, strategies to improve on the initial response to nucleoside analog therapy are likely to be beneficial, at least for a proportion of patients. We have treated 13 patients with newly diagnosed HCL (n = 11) or after failure of one prior chemotherapy (n = 2) with cladribine (5.6 mg/m2 given intravenously over 2 hours daily for 5 days) followed by 8 weekly doses of rituximab (375 mg/m2). All patients achieved a CR and minimal residual disease (MRD) assessed by consensus primer polymerase chain reaction (PCR) or flow cytometry was eradicated in 11 (92%) of 12 and in 12 (92%) of 13 of patients, respectively. There was no decline in the absolute CD4 and CD8 lymphocyte number after rituximab. We conclude that eradication of MRD in HCL is possible. Whether this leads to a reduced risk of relapse would need to be evaluated in a larger number of patients and with longer follow-up. Disease characteristics may potentially be used to identify patients that are more likely to benefit from such additional therapy.


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