Second cancer risk in hairy cell leukemia: analysis of 350 patients.

Kurzrock, Razelle; Strom, S S; Estey, E.; O'Brien, S; Keating, MJ; Jiang, Hai; Adams, Timothy E.; Talpaz, Moshe

doi:10.1200/jco.1997.15.5.1803

Cited by 100 publications

(71 citation statements)

References 13 publications

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“…[20][21][22] Two reports 20,21 suggested an increased incidence of second malignancy, the largest however 22 could not support this suspicion. In our small series, eight pts (18%) suffered from additional cancer at start of 2-CdA treatment, six of them died without any evidence of active or residual HCL, two are in CCR.…”

Section: Discussionmentioning

confidence: 73%

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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Section: Discussionmentioning

confidence: 73%

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

et al. 2004

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“…24 In the present data, 16 patients had herpes infection, and 18 developed a second malignancy (7.5%), a figure slightly lower than the 10% rate reported by Ribeiro et al 11 and Finn et al 17 Recently the Italian group reported data on 1022 patients treated by splenectomy and/or IFN, and showed that the cumulative risk of development of a second cancer was 5%, 10%, and 14% at 5, 10, and 15 years, respectively, but not associated with a significant increased risk of additional second malignancies. 25 Kurzrock et al 20 demonstrated an increase in the number of second cancers, however it was not associated with therapy. On the contrary, Au et al 26 reported an increased relative risk of second cancer among men of 2.91 (P Ͻ 0.001) related to immunosuppres-sion due to HCL or its treatment.…”

Section: Figurementioning

confidence: 99%

“…However, mortality was greater in patients with hairy cell leukemia than in the general population in a retrospective analysis of 350 patients, primarily because of disease-related infection and second malignancies. 20 Treatment with DCF was usually well tolerated. Myelosuppression was the most frequent side-effect associated with the use of DCF.…”

Section: Figurementioning

confidence: 99%

Long-term outcome with pentostatin treatment in hairy cell leukemia patients. A French retrospective study of 238 patients

Maloisel¹,

et al. 2003

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With the introduction of new drugs such as alpha-interferon (IFN) and purine analogs, the management of hairy cell leukemia (HCL) patients has changed. However, deoxycoformycin (DCF) produced higher complete remission rates than IFN. The current study was undertaken to provide long-term data on duration of overall survival (OS) and disease-free survival (DFS) and incidence of subsequent malignancies. We retrospectively analyzed the data of patients treated with DCF (4 mg/m 2 /day, every 2 weeks) from 39 French centers. In 84 of 238 included patients, DCF was the first-line therapy. Pretreatment variables influencing the achievement of complete remission, DFS, and OS were identified by multivariate analysis. Two hundred and thirty-eight patients received a median of nine cycles (range, 1-19 cycles). A complete remission was obtained in 182 of 230 evaluable patients (79%) and a partial response was obtained in 38 patients, for an overall response rate of 95.6%. In the multivariate analysis hemoglobin level less than 100 g/l and leukocytes less than 2 × 10 9 /l were parameters adversely influencing complete remission achievement. With a median followup of 63.5 months (range, 0.39-138.4 months), disease recurrence was observed in 34 of 220 responding patients (15%). The estimated 5-years and 10-years DFS was 88.1% and 68.8%, respectively. Hemoglobin level less than 100 g/l and leukocytes less than 2 × 10 9 /l were the pre-treatment variables associated with a shorter DFS. The estimated 5-year and 10-year OS were 89.4% and 88.7%, respectively. Hemoglobin level less than 100 g/l, leukocytes less than 2 × 10 9 /l, and adenopathy were significant factors of reduced survival. Hematologic toxicity was the main side-effect, followed by infection and emesis. During the period of follow-up, 18 patients developed second cancer, but the standardized incidence ratio was 0.95. Pentostatin is a highly effective regimen for hairy cell leukemia that produces durable complete responses. Toxicity of DCF is acceptable. Subsequent malignancies do not appear to be increased with pentostatin treatment.

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“…8 The occurrence of second neoplasms in patients with HCL is a well-known fact. [9][10][11][12][13][14][15] Among them, non-Hodgkin's lym- phomas are the most frequently hematological malignancies reported. 10,15,16 The association of HCL and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is considered to be exceedingly rare.…”

Section: Introductionmentioning

confidence: 99%

“…[9][10][11][12][13][14][15] Among them, non-Hodgkin's lym- phomas are the most frequently hematological malignancies reported. 10,15,16 The association of HCL and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is considered to be exceedingly rare. Thus, in an extensive computer-assisted search of the literature, only one case of transformation of CLL/SLL into HCL, 17 one case of HCL diagnosed years after the diagnosis of CLL/SLL, 18 and some cases of lymphoproliferative disorders with intermediate features between HCL and CLL/SLL [19][20][21] have been reported.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous diagnosis of hairy cell leukemia and chronic lymphocytic leukemia/small lymphocytic lymphoma: a frequent association?

et al. 2002

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The association of hairy cell leukemia (HCL) with other neoplasms, mainly non-Hodgkin's lymphomas, is well known. However, the simultaneous diagnosis of HCL and chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is rare, with only few cases of such an association having been reported. We describe three patients with a well-characterized HCL in whom a CLL/SLL population was detected. Of note, these cases represent a significant proportion (11.5%; 95% CI: 0% to 24%) of the total number of HCL cases diagnosed in our institution during the same period of time. All three patients were treated with deoxycoformycin. They achieved a complete response of the HCL, whereas the CLL/SLL population persisted in all cases. The immunoglobulin gene rearrangement analysis, in two informative cases, suggested that the HCL and CLL/SLL populations arose from different B cell clones. This study indicates that the association of HCL and CLL/SLL might be much more frequent than previously recognized. Therefore, a large panel of monoclonal antibodies, including those necessary to detect CLL/SLL, should be employed when studying patients with HCL.

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Second cancer risk in hairy cell leukemia: analysis of 350 patients.

Cited by 100 publications

References 13 publications

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

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

Long-term outcome with pentostatin treatment in hairy cell leukemia patients. A French retrospective study of 238 patients

Simultaneous diagnosis of hairy cell leukemia and chronic lymphocytic leukemia/small lymphocytic lymphoma: a frequent association?

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