Hairy cell leukemia
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Untreated
Cladribine (Leustatin)
Regimen #1, Tallman, et al. 1996
Level of Evidence: Phase II
- Cladribine (Leustatin) 0.1 mg/kg/day IV continuous infusion on days 1 to 7 (total dose per cycle: 0.7 mg/kg)
7-day course
Regimen #2, Zenhäusern, et al. 2009 (SAKK 32/98)
Level of Evidence: Phase III
- Cladribine (Leustatin) 0.14 mg/kg/day IV continuous infusion on days 1 to 5 (total dose per cycle: 0.7 mg/kg)
5-day course
Regimen #3, Zenhäusern, et al. 2009 (SAKK 32/98)
Level of Evidence: Phase III
- Cladribine (Leustatin) 0.14 mg/kg/day IV once per day on days 1, 8, 15, 22, 29
5-week course
References
- Tallman MS, Hakimian D, Rademaker AW, Zanzig C, Wollins E, Rose E, Peterson LC. Relapse of hairy cell leukemia after 2-chlorodeoxyadenosine: long-term follow-up of the Northwestern University experience. Blood. 1996 Sep 15;88(6):1954-9. link to original article contains verified protocol PubMed
- Update: Chadha P, Rademaker AW, Mendiratta P, Kim B, Evanchuk DM, Hakimian D, Peterson LC, Tallman MS. Treatment of hairy cell leukemia with 2-chlorodeoxyadenosine (2-CdA): long-term follow-up of the Northwestern University experience. Blood. 2005 Jul 1;106(1):241-6. Epub 2005 Mar 10. link to original article contains protocol PubMed content property of HemOnc.org
- Zenhäusern R, Schmitz SF, Solenthaler M, Heim D, Meyer-Monard S, Hess U, Leoncini L, Bargetzi M, Rufener B, Tobler A. Randomized trial of daily versus weekly administration of 2-chlorodeoxyadenosine in patients with hairy cell leukemia: a multicenter phase III trial (SAKK 32/98). Leuk Lymphoma. 2009 Sep;50(9):1501-11. doi: 10.1080/10428190903131755. link to original article contains protocol PubMed
Pentostatin (Nipent)
Level of Evidence: Phase II
- Pentostatin (Nipent) 5 mg/m2 IV over 2 minutes once per day on days 1 & 2
14-day cycles, continued to the point of maximal response or treatment failure
Supportive medications:
- Allopurinol (Aloprim) 300 mg PO once per day in "the initial courses of treatment" for prophylaxis
References
- Cassileth PA, Cheuvart B, Spiers AS, Harrington DP, Cummings FJ, Neiman RS, Bennett JM, O'Connell MJ. Pentostatin induces durable remissions in hairy cell leukemia. J Clin Oncol. 1991 Feb;9(2):243-6. link to original article contains protocol PubMed
Relapsed
Rituximab
Regimen, Nieva et al. Blood 2003
Level of Evidence: Phase II
- Rituximab (Rituxan) 375 mg/m2 IV weekly for 4 consecutive weeks
- Initial infusions were given at 50 mg per hour for the first 30 minutes, and if no toxicity was observed, the infusion rate was escalated at 30-minute intervals to a peak infusion rate of 300 mg per hour.
Supportive medications:
- Allopurinol (Aloprim) 300 mg PO once per day for the first 7 days of treatment
References
- Nieva J, Bethel K, Saven A. Phase 2 study of rituximab in the treatment of cladribine-failed patients with hairy cell leukemia. Blood. 2003 Aug 1;102(3):810-3. link to original article contains verified protocol PubMed