Relapsed or Refractory Hairy Cell Leukemia
Cladribine (2-chlorodeoxyadenosine, 2-CdA) and pentostatin are both highly efficacious in the treatment of patients with disease refractory to interferon-alpha.[1-4] Patients who relapse after the first course of cladribine or pentostatin often respond well to retreatment with the same or another purine analog.[5-11] Rituximab can induce durable complete remissions with minimal toxic effects in patients with multiple relapsing or refractory disease after purine analog therapy or after interferon.[12-15][Level of evidence: 3iiiDiv] The lack of subsequent immunosuppression with rituximab has made this treatment a common choice among relapsing patients in the absence of a clinical trial. Combinations of rituximab with either cladribine or pentostatin are effective in achieving complete remission and are under clinical evaluation.[10,16,17] Both anti-CD25 and anti-CD22 recombinant immunotoxins under clinical evaluation can induce complete remissions in patients whose disease is resistant to retreatment with purine analogs or rituximab.[18,19]
Trials (including the ongoing CAT-8015-1001 [NCT00462189] study and NCI-04-C-0014, which is now completed) are in the process of evaluating, or have evaluated, new therapies for this group of patients.
Aggressive, high-dose chemotherapy has been beneficial in some cases, but the associated morbidity and mortality are high. It should not be considered unless other, more frequently effective, therapies have been exhausted.
Current Clinical Trials
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with refractory hairy cell leukemia. The list of clinical trials can be further narrowed by location, drug, intervention, and other criteria.
General information about clinical trials is also available from the NCI Web site.
- Piro LD, Carrera CJ, Carson DA, et al.: Lasting remissions in hairy-cell leukemia induced by a single infusion of 2-chlorodeoxyadenosine. N Engl J Med 322 (16): 1117-21, 1990. [PUBMED Abstract]
- Tallman MS, Hakimian D, Variakojis D, et al.: A single cycle of 2-chlorodeoxyadenosine results in complete remission in the majority of patients with hairy cell leukemia. Blood 80 (9): 2203-9, 1992. [PUBMED Abstract]
- Saven A, Burian C, Koziol JA, et al.: Long-term follow-up of patients with hairy cell leukemia after cladribine treatment. Blood 92 (6): 1918-26, 1998. [PUBMED Abstract]
- Grever M, Kopecky K, Foucar MK, et al.: Randomized comparison of pentostatin versus interferon alfa-2a in previously untreated patients with hairy cell leukemia: an intergroup study. J Clin Oncol 13 (4): 974-82, 1995. [PUBMED Abstract]
- Hoffman MA, Janson D, Rose E, et al.: Treatment of hairy-cell leukemia with cladribine: response, toxicity, and long-term follow-up. J Clin Oncol 15 (3): 1138-42, 1997. [PUBMED Abstract]
- Goodman GR, Burian C, Koziol JA, et al.: Extended follow-up of patients with hairy cell leukemia after treatment with cladribine. J Clin Oncol 21 (5): 891-6, 2003. [PUBMED Abstract]
- Ribeiro P, Bouaffia F, Peaud PY, et al.: Long term outcome of patients with hairy cell leukemia treated with pentostatin. Cancer 85 (1): 65-71, 1999. [PUBMED Abstract]
- Zinzani PL, Magagnoli M, Bendandi M, et al.: Long-term follow-up of hairy cell leukemia patients treated with 2-chlorodeoxyadenosine. Haematologica 85 (9): 922-5, 2000. [PUBMED Abstract]
- Gidron A, Tallman MS: 2-CdA in the treatment of hairy cell leukemia: a review of long-term follow-up. Leuk Lymphoma 47 (11): 2301-7, 2006. [PUBMED Abstract]
- 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 145 (6): 733-40, 2009. [PUBMED Abstract]
- Gerrie AS, Zypchen LN, Connors JM: Fludarabine and rituximab for relapsed or refractory hairy cell leukemia. Blood 119 (9): 1988-91, 2012. [PUBMED Abstract]
- Hagberg H, Lundholm L: Rituximab, a chimaeric anti-CD20 monoclonal antibody, in the treatment of hairy cell leukaemia. Br J Haematol 115 (3): 609-11, 2001. [PUBMED Abstract]
- Lauria F, Lenoci M, Annino L, et al.: Efficacy of anti-CD20 monoclonal antibodies (Mabthera) in patients with progressed hairy cell leukemia. Haematologica 86 (10): 1046-50, 2001. [PUBMED Abstract]
- Thomas DA, O'Brien S, Bueso-Ramos C, et al.: Rituximab in relapsed or refractory hairy cell leukemia. Blood 102 (12): 3906-11, 2003. [PUBMED Abstract]
- Angelopoulou MK, Pangalis GA, Sachanas S, et al.: Outcome and toxicity in relapsed hairy cell leukemia patients treated with rituximab. Leuk Lymphoma 49 (9): 1817-20, 2008. [PUBMED Abstract]
- Ravandi F, O'Brien S, Jorgensen J, et al.: Phase 2 study of cladribine followed by rituximab in patients with hairy cell leukemia. Blood 118 (14): 3818-23, 2011. [PUBMED Abstract]
- Else M, Dearden CE, Matutes E, et al.: Rituximab with pentostatin or cladribine: an effective combination treatment for hairy cell leukemia after disease recurrence. Leuk Lymphoma 52 (Suppl 2): 75-8, 2011. [PUBMED Abstract]
- Kreitman RJ, Wilson WH, White JD, et al.: Phase I trial of recombinant immunotoxin anti-Tac(Fv)-PE38 (LMB-2) in patients with hematologic malignancies. J Clin Oncol 18 (8): 1622-36, 2000. [PUBMED Abstract]
- Kreitman RJ, Stetler-Stevenson M, Margulies I, et al.: Phase II trial of recombinant immunotoxin RFB4(dsFv)-PE38 (BL22) in patients with hairy cell leukemia. J Clin Oncol 27 (18): 2983-90, 2009. [PUBMED Abstract]