A Frail Hairy Cell Leukemia Patient Successfully Treated with Pegylated Interferon-α-2A

Abstract

Hairy cell leukemia (HCL) treatment in elderly, frail subjects is still unsatisfactory, and interferons, old-fashioned therapies, can be effectively used in this subset of patients. Here, to the best of our knowledge, we report for the first time an old, frail HCL patient effectively and safely treated with pegylated interferon-α-2a in monotherapy as a first-line treatment. At diagnosis, the patient arrived in a life-threating condition due to severe neutropenia and splenomegaly with high risk of splenic rupture. However, splenectomy was proposed and refused by the patient; therefore, a therapy with pegylated interferon-α-2a was initiated. After six months of therapy, the patient displayed the disappearance of palpable splenomegaly and of peripheral hairy cells at morphological examination without any drug-related adverse event. Our case report supports the use of pegylated interferon-α-2a in monotherapy as an effective and safe alternative therapeutic option in frail, elderly patients not eligible for purine analogous or targeted therapies.

Hairy cell leukemia – etiopathogenesis, diagnosis and modern therapeutic approach

“…The IFN-α treatment is also beneficial for patients with severe neutropenia, purine analogue ineligibility, and relapsed/refractory HCL. However, its use is limited due to its low CR- ( 1 , 18 , 25 , 31 , 42 , 47 ).…”

“…The subsequent side effect of the use of purine antimetabolites is myelo- and immunosuppression, which translates into longer reconstruction of hematopoiesis, periodically deepened cytopenia and greater susceptibility to infections ( 38 ). However, an indisputable advantage of purine analogues is the possibility of their administration during an active infection and adjusting the dose during treatment ( 46 , 47 ). Immunosuppression acquired by the use of cladribine can result in long-term neutropenia and impaired T cell function.…”

“…Rituximab is an example of an immunotherapeutic drug with an anticancer and immunosuppressive effect. It is a human-mouse chimeric anti-CD20 monoclonal antibody produced by genetic engineering ( 47 ). Rituximab binds specifically to the transmembrane cell differentiation antigen CD20, which is a non-glycosylated phosphoprotein found on both pre-B lymphocytes and mature B lymphocytes.…”

A hajas sejtes leukémia és kezelése

“…2020 eleje óta a rekombináns IFN-ek nem elérhetőek, gyártásuk világszerte megszűnt. A pegilált IFN-alfa2a kevesebb mellékhatással járó hetenkénti kezelés, az első adatok aktív infekcióban szenvedő HSL-betegek kezeléséről az elmúlt hónapokban jelentek meg [20,21]. [22,23].…”

“…injekciós kezelést jelent. A pegilált alfa-IFN alfa 2a kevesebb mellékhatással járó hetenkénti kezelés, a szer még aktív infekcióban szenvedő HSL betegekben is eredményesen alkalmazható [20,21].…”