Difference between revisions of "Hairy cell leukemia"
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=Untreated= | =Untreated= | ||
==Cladribine (Leustatin)== | ==Cladribine (Leustatin)== | ||
| − | ===Regimen #1, Tallman | + | ===Regimen #1, Tallman et al. 1996=== |
Level of Evidence: | Level of Evidence: | ||
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'''7-day course''' | '''7-day course''' | ||
| − | ===Regimen #2, Zenhäusern | + | ===Regimen #2, Zenhäusern et al. 2009 (SAKK 32/98)=== |
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'''5-day course''' | '''5-day course''' | ||
| − | ===Regimen #3, Zenhäusern | + | ===Regimen #3, Zenhäusern et al. 2009 (SAKK 32/98)=== |
Level of Evidence: | Level of Evidence: | ||
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Revision as of 23:21, 17 October 2013
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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
Cladribine & Rituximab
Regimen, Ravandi et al. 2011
Level of Evidence: Phase II
- Cladribine (Leustatin) 5.6 mg/m2 IV 2 hours daily for 5 days
28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started
- Rituximab (Rituxan) 375 mg/m2 IV weekly for 8 weeks
Supportive medications: All were administered at the discretion of the treating physician
- Levofloxacin (Levaquin)
- Valcyclovir (Valcyte)
- Fluconazole (Diflucan)
- Allopurinol (Aloprim)
- Filgrastim (Neupogen)
References
- Ravandi F, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Koller C, Challagundla P, York S, Brandt M, Luthra R, Burger J, Thomas D, Keating M, Kantarjian H. Phase 2 study of cladribine followed by rituximab in patients with hairy cell leukemia. Blood. 2011 Oct 6;118(14):3818-23. link to original article contains verified 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