Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial
Open Access
- 10 August 2020
- journal article
- research article
- Published by American Society of Hematology in Blood Advances
- Vol. 4 (15), 3699-3707
- https://doi.org/10.1182/bloodadvances.2020002160
Abstract
Hairy cell leukemia (HCL) remains an incurable disease. However, first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. Although there are excellent long-term data for intravenous application, similar data regarding subcutaneous administration are lacking. We therefore analyzed the long-term outcome of 3 prospective multicenter clinical trials on subcutaneous cladribine performed by the Swiss Group for Clinical Cancer Research (SAKK), which recruited 221 patients with classical HCL between 1993 and 2005. Median overall survival from start of treatment was not reached. Pretreatment anemia, higher Eastern Cooperative Oncology Group score, and higher age were associated with poorer overall survival in multivariable analysis, whereas early progression at 24 and 36 months had no significant impact on overall survival. Second-line treatment was necessary in 53 (23.7%) patients after a median of 5 (range, 0.2-20.4) years, and first retreatment was mainly monotherapy with cladribine (66%) or rituximab (15.1%) or a combination of these drugs (15.1%). A total of 44 (19.9%) patients developed second primary malignancies with a median time to occurrence of 5.7 (range, 0.01-17.5) years. Second primary malignancies were the main cause for death (14; 27.5%). Compared with a matched normal Swiss population, the incidence of second primary malignancies was not increased. However, survival of patients with HCL was slightly inferior by comparison (P = .036). In conclusion, the outcome of HCL patients treated with subcutaneous cladribine is excellent, and in most patients, 1 cycle of subcutaneous cladribine is sufficient for long-term disease control.Keywords
This publication has 47 references indexed in Scilit:
- VH4-34+ hairy cell leukemia, a new variant with poor prognosis despite standard therapyBlood, 2009
- Long‐term follow‐up of 233 patients with hairy cell leukaemia, treated initially with pentostatin or cladribine, at a median of 16 years from diagnosisBritish Journal of Haematology, 2009
- Randomized trial of dailyversusweekly administration of 2-chlorodeoxyadenosine in patients with hairy cell leukemia: a multicenter phase III trial (SAKK 32/98)Leukemia & Lymphoma, 2009
- Low dose 2-chlorodeoxyadenosine given as a single subcutaneous injection in patients with hairy cell leukemia – a multicentre trial SAKK 32/95Leukemia & Lymphoma, 2009
- The role of rituximab in combination with pentostatin or cladribine for the treatment of recurrent/refractory hairy cell leukemiaCancer, 2007
- Second Cancer Incidence and Cause-Specific Mortality Among 3104 Patients With Hairy Cell Leukemia: A Population-Based StudyJNCI Journal of the National Cancer Institute, 2007
- An update: 12-year follow-up of patients with hairy cell leukemia following treatment with 2-chlorodeoxyadenosineLeukemia, 2004
- Epidemiology of hairy cell leukemia in IcelandThe Hematology Journal, 2002
- Lasting Remissions in Hairy-Cell Leukemia Induced by a Single Infusion of 2-ChlorodeoxyadenosineThe New England Journal of Medicine, 1990
- Alpha Interferon for Induction of Remission in Hairy-Cell LeukemiaThe New England Journal of Medicine, 1984