Cladribine Treatment in Hairy Cell Leukemia

Year 2020, Volume: 7 Issue: 3, 131 - 134, 29.12.2020

Senem Maral , Murat Albayrak , Hacer Berna Afacan Öztürk , Abdulkerim Yıldız , Pınar Cömert , Buğra Sağlam , Mesut Tığlıoğlu Merih Aras

https://doi.org/10.47572/muskutd.721951

Abstract

Hairy cell leukemia (HCL), which is a rare chronic lymphoproliferative disease, progresses with relapses and remissions. With the introduction of purine analogues (PA) in the treatment, significant improvements have been achieved in the prognosis and survival of patients. In this study, we investigated the effect of PA on relapse and survival in the first line treatment with two different protocols. We retrospectively analyzed 20 HCL patients who treated with PA between 2009-2019. We compared the patients who were treated with single cycle PA and two cyclic consecutive PA treatment according to clinical features at the time of diagnosis, laboratory findings, response and relapse rates. Complete Remission (CR) and Partial Remission (PR) were achieved with equal rates in both groups (90% and 10%, resp.). Relapse was observed in one patient in each group during the 69 months of median follow-up time. A patient who was treated with one cycle PA was exitus due to non-disease cause. The superiority of two consecutive cycle 2Cd-A administration could not be demonstrated in relation to the response and relapse rates. 2Cd-A is highly effective agent as a first-line treatment option with a high response rate.

Keywords

Hairy Cell Leukemia, Cladribine, Prognosis

Saçlı Hücreli Lösemi Tedavisinde Kladribinin Prognoza Etkisi

Abstract

Saçlı hücreli lösemi (SHL) nadir görülen kronik lenfoproliferatif hastalıklar arasında yer alan, relaps ve remisyonlar ile seyreden indolent bir lenfomadır. Tedavisinde pürin analoğu (PA) kullanımı ile hastaların prognoz ve sağ kalımında önemli gelişmeler kaydedilmiştir. Bu çalışmamızda ilk basamakta kullanılan purin analogu tedavisinin iki farklı protokol ile verilmesinin nüks ve sağ kalım üzerine etkisini araştırdık. Kliniğimizde 2009-2019 yılları arasında SHL nedeniyle PA ile tedavi edilen 20 vakayı retrospektif olarak inceledik. Bunlardan tek siklus PA uygulanan hastalar ile iki siklüs ardışık PA tedavisi alan hasta gruplarını tanı anındaki klinik özellikleri, laboratuvar bulguları yanıt ve nüks oranları açısından karşılaştırdık. Her iki grupta yanıt oranları eşit olmakla birlikte, ilk basamak tedaviye tam yanıt oranı %90, kısmı yanıt oranı %10 olarak değerlendirilmiştir. Hastalarımızın median takip süresi 69 aydır ve bu süre içerisinde her iki gruptan birer hastada nüks izlenmiştir. Tek siklus tedavi alan hastalardan 1 tanesi hastalık dışı nedenle eks olmuştur. Ardışık iki siklus 2Cd-A uygulanmasının yanıt ve nüks oranı ilişkili üstünlüğü gösterilememiştir. İlk basamak tedavide uygulanan 2Cd-A, yüksek yanıt oranı ile etkili bir ajandır.

Keywords

Saçlı Hücreli Lösemi, Kladribin, Prognoz

References

• 1. Bouroncle BA, Wiseman BK, Doan CA. Leukemic reticuloendotheliosis. Blood. 1958;13(7):609-30.
• 2. Golomb HM, Catovsky D, Golde DW. Hairy cell leukemia: A clinical review based on 71 cases. Ann Intern Med. 1978;89(5 Pt 1):677-83.
• 3. Savoie L, Johnston JB. Hairy cell leukemia. Curr Treat Options Oncol. 2001;2(3):217-24.
• 4. Allsup DJ, Cawley JC. The diagnosis and treatment of hairy cell leukemia. Blood Rev. 2002;16(4):255-62.
• 5. Saven A, Burian C, Koziol JA, Piro LD. Long-term follow-up of patients with hairy cell leukemia after cladribine treatment. Blood. 1998;92(6):1918-26.
• 6. Tadmor T, Polliack A. Epidemiology and environmental risk in hairy cell leukemia. Best Pract Res Clin Haematol. 2015;28(4):175-9.
• 7. Goodman GR, Burian C, Koziol JA, Saven A. Extended follow-up of patients with hairy cell leukemia after treatment with cladribine. J Clin Oncol. 2003;21(5):891-96.
• 8. Maloisel F, Benboubker L, Gardembas M, et al. Long-term outcome with pentostatin treatment in hairy cell leukemia patients: a French retrospective study of 238 patients. Leukemia. 2003;17(1):45-51.
• 9. Else M, Ruchlemer R, Osuji N, et al. Long remissions in hairy cell leukemia with purine analogs: a report of 219 patients with a median follow-up of 12.5 years. Cancer. 2005;104(11):2442-8.
• 10. Else M, Dearden CE, Matutes E, et al. Long-term follow-up of 233 patients with hairy cell leukaemia, treated initially with pentostatin or cladribine, at a median of 16 years from diagnosis. Br J Haematol. 2009;145(6):733-40.
• 11. Swerdlow SH, Campo E, Pileri SA, et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood. 2016;127(20):2375-90.
• 12. Smith A, Howell D, Patmore R, Jack A, Roman E. Incidence of haematological malignancy by sub-type: a report from the Haematological Malignancy Research Network. Br J Cancer. 2011;105(11):1684-92.
• 13. Grever MR. How I treat hairy cell leukemia. Blood. 2010;115(1):21-8.
• 14. Rosenberg JD, Burian C, Waalen J, Saven A. Clinical characteristics and long-term outcome of young hairy cell leukemia patients treated with cladribine: a single-institution series. Blood. 2014;123(2):177-83.
• 15. Juliusson G, Heldal D, Hippe E, et al. Subcutaneous injections of 2-chlorodeoxyadenosine for symptomatic hairy cell leukemia. J Clin Oncol. 1995;13(4):989-95.
• 16. Robak T, Błasińska-Morawiec M, Krykowski E, et al. 2-chlorodeoxyadenosine (2-CdA) in 2-hour versus 24-hour intravenous infusion in the treatment of patients with hairy cell leukemia. Leuk Lymphoma. 1996;22(1-2):107-11.
• 17. Tallman MS. Current treatment strategies for patients with hairy cell leukemia. Rev Clin Exp Hematol. 2002;6(4):389-450.
• 18. Dearden CE, Matutes E, Hilditch BL, Swansbury GJ, Catovsky D. Long-term follow-up of patients with hairy cell leukaemia after treatment with pentostatin or cladribine. Br J Haematol. 1999;106(2):515-9.
• 19. Au WY, Klasa RJ, Gallagher R, Le N, Gascoyne RD, Connors JM. Second malignancies in patients with hairy cell leukemia in british columbia: a 20-year experience. Blood. 1998;92(4):1160-4.
• 20. Hisada M, Chen BE, Jaffe ES, Travis LB. Second cancer incidence and cause-specific mortality among 3104 patients with hairy cell leukemia: a population-based study. J Natl Cancer Inst. 2007;99(3):215-22.