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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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Submitted November 21, 2005
Accepted February 14, 2006
Eradication of minimal residual disease (MRD) in hairy cell leukemia (HCL)
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
Department of Leukemia, University of Texas - MD Anderson Cancer Center, Houston, Texas, USA
Department of Hematopathology, University of Texas - MD Anderson Cancer Center, Houston, Texas, USA
Department of Biostatistics, University of Texas - MD Anderson Cancer Center, Houston, Texas, USA
* Corresponding author; email: fravandi{at}mdanderson.org.
Although the nucleoside analogs cladribine and pentostatin produce high response rates in patients with 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 upon the initial response to nucleoside analog therapy are likely to be beneficial, at least for a proportion of patients. We have treated thirteen 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 MRD assessed by consensus primer PCR or flow cytometry was eradicated in 11 of 12 (92%) and in 12 of 13 (92%) 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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