title: Long remissions in hairy cell leukemia with purine analogs: a report of 219 patients with a median follow-up of 12.5 years.
abstract: BACKGROUND
  Both pentostatin and cladribine have efficacy in hairy cell leukemia (HCL), but it is not known which agent achieves better results.
  
  
  METHODS
  We reviewed a series of 219 patients with HCL, with median follow-up from diagnosis of 12.5 years (range 1.0 -34.6 yrs), treated with either pentostatin (n = 185) or cladribine (n = 34), to compare these agents and assess the potential for cure.
  
  
  RESULTS
  Overall response to pentostatin was 96% with a complete response (CR) in 81% and a median disease-free survival (DFS) of 15 years. Response to first-line cladribine was 100% with a CR in 82% and DFS of 11+ years. The relapse rates at 5 years and 10 years were 24% and 42%, respectively, with pentostatin, and 33% and 48% with cladribine. Survival at 10 years was respectively 96% and 100%. CR rates decreased with each sequential relapse through 69% to 45% (P < or = 0.001). Patients achieving CR after first-line treatment had a significantly longer DFS (P = 0.00007) than those achieving a partial response; a similar result was seen after second-line therapy (P = 0.00001). DFS also declined with sequential treatment (P = 0.00005).
  
  
  CONCLUSIONS
  We have shown equivalent efficacies for both agents in the treatment of HCL, with DFS showing no plateau. True cure in HCL remains elusive, but the addition of monoclonal antibodies may be beneficial. Our results suggest that achieving CR should remain the main goal of treatment.
authors.affiliation: Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom.
authors.forename: Monica
authors.initials: M
authors.lastname: Else
authors.forename: Rosa
authors.initials: R
authors.lastname: Ruchlemer
authors.forename: Nnenna
authors.initials: N
authors.lastname: Osuji
authors.forename: Ilaria
authors.initials: I
authors.lastname: Del Giudice
authors.forename: Estella
authors.initials: E
authors.lastname: Matutes
authors.forename: Anthony
authors.initials: A
authors.lastname: Woodman
authors.forename: Andrew
authors.initials: A
authors.lastname: Wotherspoon
authors.forename: John
authors.initials: J
authors.lastname: Swansbury
authors.forename: Claire
authors.initials: C
authors.lastname: Dearden
authors.forename: Daniel
authors.initials: D
authors.lastname: Catovsky
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D017338:Cladribine / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D015649:Pentostatin / Q000627:therapeutic use*; D012189:Retrospective Studies; D013156:Splenectomy; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D015649:Pentostatin; D017338:Cladribine