Long remissions in hairy cell leukemia with purine analogs: a report of 219 patients with a median follow-up of 12.5 years.
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.
Else
Monica
M
Section of Haemato-Oncology, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ICR), Sutton, United Kingdom.
Ruchlemer
Rosa
R
Osuji
Nnenna
N
Del Giudice
Ilaria
I
Matutes
Estella
E
Woodman
Anthony
A
Wotherspoon
Andrew
A
Swansbury
John
J
Dearden
Claire
C
Catovsky
Daniel
D
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
D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D015649:Pentostatin; D017338:Cladribine