Outcome and toxicity in relapsed hairy cell leukemia patients treated with rituximab

Angelopoulou, Maria K.; Pangalis, Gerassimos A.; Sachanas, Sotirios; Kokoris, Styliani I.; Anargyrou, Konstantinos; Galani, Zacharoula; Kalpadakis, Christina; Vassilakopoulos, Theodoros P.

doi:10.1080/10428190802163289

Cited by 17 publications

(11 citation statements)

References 11 publications

(16 reference statements)

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“…Several publications have reported the use of rituximab to treat relapses [11,12,13,14,15,16]. Although PA are very effective agents in the treatment of HCL, approximately one third of patients will experience relapse within 5 years of therapy [22].…”

Section: Discussionmentioning

confidence: 99%

“…The response rates (RR) range from 26 to 80%, including 10–62% CR, with a satisfactory safety profile. Certain factors may predict response: low tumor burden [12,13,16], low number of previous treatments [15], previous splenectomy [12] and absence of spleen enlargement [16]. The optimum number of rituximab courses has yet to be determined, although an extended dosing schedule of 8 once-weekly infusions appears to be more effective [14].…”

Section: Discussionmentioning

confidence: 99%

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Which Role for Rituximab in Hairy Cell Leukemia? Reflections on Six Cases

Malfuson

Fagot²,

Konopacki³

et al. 2009

Acta Haematol

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Hairy cell leukemia (HCL) is a rare, chronic, B-cell, lymphoproliferative disorder. Treatment has been revolutionized by the advent of interferon (IFN)-α and purine analogs (PA). First-line therapy with PA yields complete response rates of 75–100%, with many long-lasting remissions. In the event of profound neutropenia and/or infectious complications, a short sequence of IFN-α may precede PA treatment. Because of the excellent results achieved with PA therapy, the potential role of rituximab (an anti-CD20 monoclonal antibody that is highly effective against most B-cell lymphomas) in HCL has yet to be elucidated. Six HCL cases treated with rituximab are reported herein with a view to elucidating the potential role of the drug in HCL. The indications essentially consist of relapsing or refractory disease, avoiding the cumulative toxicity of PA, consolidation therapy in order to eradicate minimal residual disease, and first-line therapy for patients with contraindications to PA and IFN-α.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Which Role for Rituximab in Hairy Cell Leukemia? Reflections on Six Cases

Malfuson

Fagot²,

Konopacki³

et al. 2009

Acta Haematol

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“…Including ours, 12 cases of frontline rituximab monotherapy, the majority of which due to existing neutropenia have been recorded in the literature [1,[5][6][7] receiving approximately 4-8 weekly infusions. Forty-two percent of patients (5/12) achieved some response [5][6][7], while in 58 % (7/12) of patients, complete remission was noted ranging from 1 to 54 months of follow-up [1,6,5].…”

Section: Dear Editormentioning

confidence: 88%

“…Forty-two percent of patients (5/12) achieved some response [5][6][7], while in 58 % (7/12) of patients, complete remission was noted ranging from 1 to…”

Section: Rituximab As Frontline Monotherapy In Untreated Hairy Cell Lmentioning

confidence: 95%

Rituximab as frontline monotherapy in untreated hairy cell leukemia patients

et al. 2015

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Rituximab as frontline monotherapy in untreated hairy cell leukemia patientsWe have read with great interest the recent article by Leclerc et al. [1] assessing rituximab therapy in hairy cell leukemia, following recent guidelines upon its usage in combination with or without purine analogs in relapsed/refractory disease [2,3]. The authors [1] make an important statement concerning the scarce data upon the use of frontline rituximab as monotherapy, in patients unable to receive other agents due to associated cytopenias, progressive disease, patients who are very elderly, and/or have a poor performance status. Of note in the latter group, attending physicians are not uncommonly met with patients with second malignancy including the solid organ, skin, and lymphoid neoplasms, as shown in large epidemiological studies [4].We hereby would like to report our recent experience with a 70-year-old male patient admitted to our department with shortness of breath in the context of a newly diagnosed pleural effusion (Fig. 1a) for further evaluation. Initial investigation revealed mild pancytopenia (WBC, 2.20 K/μl; poly, 46 %; lymph, 52 %; mono, 2 %; PLT, 135.00 K/μl; Hb, 11.5 g/dl) in the presence of hairy cells in peripheral blood smear, along with several nodular lesions of nonspecific characteristics, approximately~1 cm at the top and posterior segments of the right and left lungs (Fig. 1b). Bone marrow trephine biopsy confirmed 40-50 % lymphocyte infiltration (Fig. 1c, d), the great majority being strongly positive for CD20 (Fig. 1e) and less for CD79a, while 15 % of cells were positive for DBA44 (Fig. 1f). Immunophenotypic analysis of peripheral blood revealed a small CD103(+) population, supporting the diagnosis of B hairy cell leukemia. However, fine needle biopsy staining of pulmonary lesions was positive for TTF-1 and surfactant apoprotein, leading to the diagnosis of synchronous adenocarcinoma of the lung. A PET-CT scan confirmed lesions in the right and left upper lung fields, together with abnormal signal along the right pleura, spleen, and right scapula, along with a newly identified right axillary lymph node. Due to the second malignancy and existing cytopenias, we decided to treat this patient with rituximab alone. He received a weekly course of rituximab (375 mg/m 3 ) for 4 weeks, followed by five monthly courses. Marked increase and complete normalization of blood count were noted after the first 4 cycles and the end of therapy, respectively. A month following the end of the last course, bone marrow trephine biopsy confirmed complete remission of hairy cell leukemia; hence, the patient went on to receive chemotherapy for his lung cancer.Including ours, 12 cases of frontline rituximab monotherapy, the majority of which due to existing neutropenia have been recorded in the literature [1, 5-7] receiving approximately 4-8 weekly infusions. Forty-two percent of patients (5/12) achieved some response [5][6][7], while in 58 % (7/12) of patients, complete remission was noted ranging from 1 to

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“…In the majority of patients, a single course of the nucleoside analog, cladribine (also known as 2-chlorodeoxyadenosine, 2-CDA), given as a continuous intravenous infusion over 7 days, induces a durable complete response with resolution of splenomegaly and cytopenias [34]. Among the small proportion of patients who relapse, therapeutic options include re-treatment with cladribine or rituximab monotherapy [35].…”

Section: Clinical Featuresmentioning

confidence: 99%