Commentary on Abstract #3116

OncologyONCOLOGY Vol 14 No 3
Volume 14
Issue 3

Hairy cell leukemia is one of the success stories of hematologic oncology. The purine analogs cladribine (Leustatin) and pentostatin (Nipent) are similarly active, with responses in more than 90% of patients, including 65% to 85% CRs

Hairy cell leukemia is one of the success stories of hematologic oncology. The purine analogs cladribine (Leustatin) and pentostatin (Nipent) are similarly active, with responses in more than 90% of patients, including 65% to 85% CRs (Grever et al: J Clin Oncol 13:974-982, 1995; Saven et al: Blood 92:1918-1926, 1998; Cheson et al: J Clin Oncol 16:3007-3015, 1998; Kreitman and Cheson: Hematology 4:283-303, 1999) Whether patients are cured is controversial, since more than 30% will relapse with prolonged follow-up. Relapses are often silent, but when retreatment is needed, patients may experience a durable response to the same or the alternate purine analog.

However, a few patients (often those with hairy cell variants) do not respond to initial therapy, and others either relapse after an initial response or cannot tolerate purine analog therapy. New treatment approaches are needed for these patients. Recently, Kreitman et al (Blood 94:3340-3348, 1999) treated four patients who were resistant to both interferon and cladribine with LMB-2, a recombinant immunotoxin that targets CD25. Major responses occurred in all patients, with the single CR lasting longer than 11 months.

At the ASH meeting, Thomas et al (abstract #3116) reported their preliminary experience with eight weekly doses of rituximab in 10 patients with hairy cell leukemia, 2 of whom had refractory disease and 8 of whom had relapsed following a median of three prior therapies, including cladribine. Among the 9 patients who were evaluable for response, there were 3 CRs, 2 CRs with minimal residual disease, and 1 PR. Follow-up was too short to determine the durability of those responses.

Whether rituximab plays a major role in the treatment of hairy cell leukemia will require further study. However, since the mechanisms of antibodies differ from those of the purine analogs, rituximab should be considered earlier in the treatment of patients with hairy cell variants.

Articles in this issue

Comparative Economic Analysis of the Treatment of Relapsed Low-Grade B-Cell Non-Hodgkin’s Lymphoma (NHL) in France Using CHOP, Fludarabine, or Rituximab
FHIT Gene, Smoking, and Cervical Cancer
Final Report on the Safety and Efficacy of Retreatment With Rituximab for Patients With Non-Hodgkins Lymphoma
Prospective, Randomized, Controlled Study of Zevalin Radioimmunotherapy Compared to Rituximab Immunotherapy for B-Cell, Non-Hodgkins Lymphoma: Interim Results
IOM Medical Error Estimates Questioned, But Legislation Considered
Less Toxic Therapies for Hodgkin’s Disease May Reduce Secondary Cancers
Preserving Fertility in Young Women With Ovarian Cancer Does Not Decrease Survival
Iodine-131 Tositumomab for Patients With Transformed, Low-Grade Non-Hodgkin’s Lymphoma: Overall Clinical Trial Experience
Survival Rates Significantly Worse For African-Americans With Endometrial Cancer
Rituximab Has Significant Activity in Patients With Chronic Lymphocytic Leukemia
Responders to Rituximab Show Continued Tumor Regression Over Time and a Progression-Free Survival That Correlates With Response Classification
PhRMA Criticizes FDA’s Proposed Rule on Antibiotic Approvals
Phase II Study of Rituximab in Combination With CHOP in Patients With Previously Untreated Intermediate- or High-Grade Non-Hodgkin’s Lymphoma
New Antibiotic Effective in Treating Gram-Positive Bacteremia
Reduced-Dose Zevalin Radioimmunotherapy for Relapsed or Refractory B-Cell Non-Hodgkin’s Lymphoma Patients With Preexisting Thrombocytopenia: Report of Interim Results of a Phase II Trial
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