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Blood, 1 November 2000, Vol. 96, No. 9, pp. 2981-2986
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Long-term follow-up of remission duration, mortality, and second
malignancies in hairy cell leukemia patients treated with
pentostatin
Ian W. Flinn,
Kenneth J. Kopecky,
M. Kathryn Foucar,
David Head,
John M. Bennett,
Robert Hutchison,
William Corbett,
Peter Cassileth,
Thomas Habermann,
Harvey Golomb,
Kanti Rai,
Elizabeth Eisenhauer,
Frederick Appelbaum,
Bruce Cheson, and
Michael R. Grever
From the Johns Hopkins University, Baltimore, MD;
Southwest Oncology Group Statistical Center, Seattle, WA; University of
New Mexico Hospital, Albuquerque, NM; St. Jude Children's Research
Hospital, Memphis, TN; University of Rochester, Rochester, NY; SUNY
Health Science Center at Syracuse, Syracuse, NY; Kingston General
Hospital, Kingston, Ontario, Canada; University of Miami, Miami, FL;
Mayo Clinic, Rochester, MN; University of Chicago, Chicago, IL; Long
Island Jewish Hospital, New Hyde Park, NY; Puget Sound Oncology
Consortium, Seattle, WA; National Cancer Institute of Canada Clinical
Trials Group, Kingston, Ontario, Canada; National Cancer Institute,
Bethesda, MD; Ohio State University, Columbus, OH.
The nucleoside analogue, pentostatin, has demonstrated high
complete response rates and long relapse-free survival times in patients with hairy cell leukemia, a disease that historically had been
unresponsive to treatment. Long-term data on duration of overall
survival and relapse-free survival and incidence of subsequent
malignancies with this agent are lacking. Patients completing the
treatment phase of a randomized, intergroup study who received
pentostatin as an initial treatment or who crossed over after failure
of interferon alpha were followed for survival, relapse, and diagnosis
of subsequent malignancies. Two hundred forty-one patients
treated with pentostatin as initial therapy (n = 154) or who crossed
over after failure of interferon alpha (n = 87) were followed for a
median duration of 9.3 years. Estimated 5- and 10-year survival rates
(95% confidence interval) for all patients combined were 90%
(87%-94%) and 81% (75%-86%), respectively. In the 173 patients with a confirmed complete response to pentostatin treatment,
5- and 10-year relapse-free survival rates were 85% (80%-91%) and
67% (58%-76%), respectively. Survival curves for patients
initially treated with pentostatin and those crossed over were similar.
Only 2 of 40 deaths were attributed to hairy cell leukemia. The
mortality rate and incidence of subsequent malignancies were not higher
than expected in the general population. Pentostatin is a highly
effective regimen for hairy cell leukemia that produces durable
complete responses. Subsequent malignancies do not appear to be
increased with pentostatin treatment.
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