title: Rituximab with pentostatin or cladribine: an effective combination treatment for hairy cell leukemia after disease recurrence.
abstract: The purine analogs pentostatin and cladribine are effective treatments for hairy cell leukemia (HCL). However, alternative treatments are needed for patients with recurrent disease. We reviewed retrospectively data from 18 patients who were retreated with either pentostatin (n = 12) or cladribine (n = 6) in combination with rituximab, after 1-6 (median 2) previous treatments with either purine analog as a single agent. All 18 patients responded to therapy, with a complete response (CR) rate of 89%. This compared favorably with CR rates of 68% after second-line therapy and 47% after third-line therapy in 88 patients retreated one or more times with a purine analog alone. Toxicity with the combination treatment was minimal. At a median follow-up of 36 months (range 5-83 months) all 16 complete responders remained in CR, while one partial responder developed recurrent disease at 10 months. The estimated recurrence rate at 3 years was 7%. This compares with 21% after second-line therapy and 42% after third-line therapy in the 88 patients retreated with a purine analog alone. Furthermore, it was a marked improvement on the 55% recurrence at 3 years previously seen in these same 18 patients after their own first-line treatment with single-agent pentostatin or cladribine (p = 0.006). The combination of a purine analog with rituximab was safe and effective for patients with recurrent HCL. The results suggest an added benefit compared with single-agent purine analog therapy.
authors.affiliation: The Institute of Cancer Research and the Royal Marsden NHS Trust, Sutton, UK.
authors.forename: Monica
authors.initials: M
authors.lastname: Else
authors.forename: Claire E
authors.initials: CE
authors.lastname: Dearden
authors.forename: Estella
authors.initials: E
authors.lastname: Matutes
authors.forename: Francesco
authors.initials: F
authors.lastname: Forconi
authors.forename: Francesco
authors.initials: F
authors.lastname: Lauria
authors.forename: Humayun
authors.initials: H
authors.lastname: Ahmad
authors.forename: Susan
authors.initials: S
authors.lastname: Kelly
authors.forename: Anandika
authors.initials: A
authors.lastname: Liyanage
authors.forename: Vijitha
authors.initials: V
authors.lastname: Ratnayake
authors.forename: Jagadeesan
authors.initials: J
authors.lastname: Shankari
authors.forename: Ioana
authors.initials: I
authors.lastname: Whalley
authors.forename: Daniel
authors.initials: D
authors.lastname: Catovsky
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017338:Cladribine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007943:Leukemia, Hairy Cell / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015649:Pentostatin / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D012189:Retrospective Studies; D000069283:Rituximab; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D015649:Pentostatin; D017338:Cladribine; D000069283:Rituximab