Rituximab in relapsed or refractory hairy cell leukemia

Thomas, Deborah A.; O’Brien, Susan; Bueso‐Ramos, Carlos E.; Faderl, Stefan; Keating, Michael J.; Giles, Francis J.; Cortes, Jorge; Kantarjian, Hagop M.

doi:10.1182/blood-2003-02-0630

Cited by 155 publications

(87 citation statements)

References 46 publications

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“…In this latter situation, the relapse rate we observe (63 %) is higher than the ones previously reported in the literature (ranging from 0 to 50 %) [9][10][11][12][13]. The longest follow-up in our cohort (median 45 months for these patients) may explain this difference.…”

Section: Discussioncontrasting

confidence: 74%

“…The median number of rituximab infusions per treatment course was 4 (range [3][4][5][6][7][8][9][10][11][12]. Most of the patients received either four or eight infusions (65 and 15 % of cases, respectively).…”

Section: Rituximab Therapymentioning

confidence: 99%

“…It was first used in relapsed patients with HCL more than 10 years ago [8], and several series of patients treated with rituximab as monotherapy were published in the following decade, reporting response rates ranging from 25 to 80 % [9][10][11][12][13]. These encouraging results have led to combine rituximab with PA, both in previously untreated and in relapsed patients.…”

Section: Introductionmentioning

confidence: 99%

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Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases

et al. 2014

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The purine analogs (PAs) cladribine and pentostatin have transformed the prognosis of hairy cell leukemia (HCL). However, some patients still relapse after PAs, or fail to reach an optimal response, and new agents are needed to further improve treatment outcome. We retrospectively studied 41 HCL patients from 10 centers in France and Belgium, who received 49 treatment courses with the anti-CD20 monoclonal antibody rituximab. Most of the patients were treated at relapse (84 % of cases) and rituximab was combined to a PA in 41 % of cases. Overall, response rate is 90 % including 71 % complete hematologic responses (CHRs). Frontline treatment, combination therapy, and absolute neutrophil count were associated with response in multivariate analysis. Three-year relapse-free and overall survivals are 68 and 90 %, respectively. When combined to a PA, rituximab yields a 100 % response rate, even beyond frontline therapy. In contrast, response rate is only 82 % (59 % CHR) when rituximab is used alone. In this latter setting, relapse rate is 56 % and median time to relapse is 17.5 months. All eight patients who were treated two times with the antibody responded again to retreatment. We confirm the high efficacy of the combination rituximab + PA. However, when rituximab is used as monotherapy, response rate is lower and the high relapse rate is a concern. Prospective clinical trials are needed to confirm the superiority of the combination rituximab + PA over PA alone, both as frontline therapy and at relapse.

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Section: Discussioncontrasting

confidence: 74%

Section: Rituximab Therapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases

et al. 2014

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“…[24][25][26] Although CdA is highly effective in HCl, even at first relapse, a promising alternative for treating second relapse or primary refractory HCL might be the use of rituximab in the future. First results with this monoclonal antibody in HCL are promising, 18 but also somewhat controversial. 27 Rituximab should be explored further in this disease, also with regard to the eradication of minimal disease and in combination with 2-CdA.…”

Section: Discussionmentioning

confidence: 99%

“…In a recent paper, 18 a definition for complete responders with minimal residual disease (CR-RD) was given. We restricted this to pts with o5% of hairy cells detected by immunocytology and/or immunohistology.…”

Section: Discussionmentioning

confidence: 99%

An update: 12-year follow-up of patients with hairy cell leukemia following treatment with 2-chlorodeoxyadenosine

et al. 2004

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Long-term results of both pretreated and previously untreated patients (pts) with hairy cell leukemia (HCL) using uniformly a single 7-day course of 2-chlorodeoxyadenosine (2-CdA) by continuous infusion are reported. In addition, the probability of obtaining another response with this drug in pts who relapsed after 2-CdA treatment will be addressed. A total of 44 consecutive pts (34 males, 10 females) with a median age of 57 years (range 33-77) at the time of initiation of 2-CdA treatment were analyzed. In all, 11 pts were pretreated with either splenectomy (n ¼ 6), interferon a (n ¼ 9) or deoxycoformycin (dCF) (n ¼ 3) or all procedures in sequence. Two pts treated with dCF did not respond to dCF, but only 2-CdA. The median time to the start of 2-CdA treatment of the 11 pretreated pts was 47 months (mo) (10-160). Out of 44, 43 (98%) achieved complete response (CR) (13 pts with residual disease-RD), one pt reached a good partial response with a single cycle of 2-CdA. Out of 44 pts, 13 had no nonhematologic toxicities at all. Toxicities (WHO grade I-IV) were mainly of grade I and II, in one pt grade IV infectious complication. Bone marrow biopsies were performed at the time of recovery of hematopoiesis, thereafter at 2-3 mo intervals, thereafter at 6 mo, and finally annually in 35 pts. The median follow-up is 8.5 years (0.1-12.2). Disease-free survival from the start of 2-CdA treatment is 36% at 12 years (median 8.4 years), 17/44 pts relapsed. Nine of these pts were treated with 2-CdA again, eight achieved a second CR (median 2.5 yrs), one pt did not respond. Eight of our cohort had a second malignancy before receiving 2-CdA. Six pts died in CR due to the second malignancy. The overall survival at 12 years after the start of 2-CdA treatment is 79%. 2-CdA is a safe and effective treatment of HCL inducing complete remissions in the majority of pts with only a single cycle of 2-CdA, and a paucity of toxicities. Responses are durable and long-lasting. Pts who relapsed following treatment with 2-CdA responded to subsequent retreatment with 2-CdA.

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Current Therapy and New Directions in the Treatment of Hairy Cell Leukemia

2016

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Hairy cell leukemia (HCL) is a chronic B-cell leukemia noted for an indolent course that ultimately results in cytopenias and massive splenomegaly. Whereas treatment with the nucleoside purine analogues cladribine and pentostatin results in lengthy remissions in nearly all patients with HCL, most patients will experience relapse while a small percentage of patients' disease fails to respond to therapy in the first place. Retreatment with a purine nucleoside analogue often leads to an effective but limited response. For decades, few other viable therapeutic options were available to these patients who required retreatment. Recently, new insights into the mechanism of disease of HCL have led to research in new potential treatment agents, either alone or with a purine nucleoside analogue. Clinical trials with rituximab, bendamustine, and conjugate immunotoxins will reveal what role these therapies will have in HCL treatment. A better understanding of the BRAF/MEK/ERK pathway and the B-cell signaling pathway has allowed further exploration into the novel drugs vemurafenib, dabrafenib, trametinib, and ibrutinib.

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Rituximab in relapsed or refractory hairy cell leukemia

Cited by 155 publications

References 46 publications

Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases

Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases

An update: 12-year follow-up of patients with hairy cell leukemia following treatment with 2-chlorodeoxyadenosine

Current Therapy and New Directions in the Treatment of Hairy Cell Leukemia

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