Eradication of minimal residual disease in hairy cell leukemia.
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/m(2) given intravenously over 2 hours daily for 5 days) followed by 8 weekly doses of rituximab (375 mg/m(2)). 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.
Department of Leukemia, University of Texas, M.D. Anderson Cancer Center, Houston, TX 77030, USA. fravandi@mdanderson.org
Farhad
F
Ravandi
Jeffrey L
JL
Jorgensen
Susan M
SM
O'Brien
Srdan
S
Verstovsek
Charles A
CA
Koller
Stefan
S
Faderl
Francis J
FJ
Giles
Alessandra
A
Ferrajoli
William G
WG
Wierda
Shirley
S
Odinga
Xuelin
X
Huang
Deborah A
DA
Thomas
Emil J
EJ
Freireich
Dan
D
Jones
Michael J
MJ
Keating
Hagop M
HM
Kantarjian
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D018791:CD4 Lymphocyte Count; D017338:Cladribine / Q000008:administration & dosage; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000097:blood / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D016133:Polymerase Chain Reaction; D012008:Recurrence; D012074:Remission Induction; D000069283:Rituximab
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D017338:Cladribine; D000069283:Rituximab