Revision as of 17:16, 28 February 2023

12 regimens on this page 17 variants on this page

Guidelines

ESMO

2015: Robak et al. Hairy cell leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Hairy Cell Leukemia Foundation

2017: Grever et al. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia

NCCN

NCCN Guidelines - Hairy Cell Leukemia

Untreated

Cladribine monotherapy

Regimen variant #1, 0.09 mg/kg/day x 7 days

Study	Years of enrollment	Evidence
Saven et al. 1998	1986-1993	Non-randomized (RT)

Chemotherapy

Cladribine (Leustatin) 0.09 mg/kg/day IV continuous infusion over 7 days, started on day 1 (total dose: 0.63 mg/kg)

7-day course

Regimen variant #2, 0.1 mg/kg/day x 7 days

Study	Years of enrollment	Evidence
Piro et al. 1990	1986-1989	Pilot, <20 pts
Tallman et al. 1996	1991-1995	Phase 2

Chemotherapy

Cladribine (Leustatin) 0.1 mg/kg/day IV continuous infusion over 7 days, started on day 1 (total dose: 0.7 mg/kg)

7-day course

Regimen variant #3, 0.12 mg/kg/day x 5 days

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Robak et al. 1999	1991-1997	Phase 2
Robak et al. 2007	1998-2005	Phase 3 (C)	Cladribine; weekly	Did not meet primary endpoint of CR rate

Chemotherapy

Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once per day on days 1 to 5

5-day course

Regimen variant #4, 0.14 mg/kg/day x 5 days

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Zenhäusern et al. 2009 (SAKK 32/98)	1998-2005	Phase 3 (C)	Cladribine; weekly	Did not meet primary endpoint of average leukocyte count within 6 weeks from randomization

Chemotherapy

Cladribine (Leustatin) 0.14 mg/kg SC once per day on days 1 to 5

5-day course

Regimen variant #5, 0.15 mg/kg/day x 5 days

Study	Years of enrollment	Evidence
Damasio et al. 1998	NR in abstract	Phase 2

Chemotherapy

Cladribine (Leustatin) 0.15 mg/kg IV over 2 hours once per day on days 1 to 5

5-day course

References

Piro LD, Carrera CJ, Carson DA, Beutler E. Lasting remissions in hairy-cell leukemia induced by a single infusion of 2-chlorodeoxyadenosine. N Engl J Med. 1990 Apr 19;322(16):1117-21. link to original article contains dosing details in abstract PubMed
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 dosing details in manuscript PubMed
1. 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 dosing details in abstract PubMed content property of HemOnc.org
Damasio EE, Resegotti L, Masoudi B, Bruni R, Cerri R, Isaza A, Clavio M, Risso M, Rossi E, Spriano M, Truini M; Italian Group for the Hairy Cell Leukemia. Five day intermittent vs seven day continuous 2-chlorodeoxyadenosine infusion for the treatment of hairy cell leukemia: a study by Italian Group for the Hairy Cell Leukemia. Recenti Prog Med. 1998 Feb;89(2):68-73. PubMed
Saven A, Burian C, Koziol JA, Piro LD. Long-term follow-up of patients with hairy cell leukemia after cladribine treatment. Blood. 1998 Sep 15;92(6):1918-26. link to original article PubMed
Robak T, Błasińska-Morawiec M, Błoński J, Hellmann A, Hałaburda K, Konopka L, Kotlarek-Haus S, Potoczek S, Hansz J, Dmoszyńska A, Urasiński I, Zdziarska B, Dwilewicz-Trojaczek J, Hołowiecki J, Skotnicki AB. 2-chlorodeoxyadenosine (cladribine) in the treatment of hairy cell leukemia and hairy cell leukemia variant: 7-year experience in Poland. Eur J Haematol. 1999 Jan;62(1):49-56. link to original article PubMed
Robak T, Jamroziak K, Gora-Tybor J, Blonski JZ, Kasznicki M, Dwilewicz-Trojaczek J, Wiater E, Zdunczyk A, Dybowicz J, Dmoszynska A, Wojtaszko M, Zdziarska B, Calbecka M, Kostyra A, Hellmann A, Lewandowski K, Stella-Holowiecka B, Sulek K, Gawronski K, Skotnicki AB, Nowak W, Zawilska K, Molendowicz-Portala L, Kloczko J, Sokolowski J, Warzocha K, Seferynska I, Ceglarek B, Konopka L; PALG. Cladribine in a weekly versus daily schedule for untreated active hairy cell leukemia: final report from the Polish Adult Leukemia Group (PALG) of a prospective, randomized, multicenter trial. Blood. 2007 May 1;109(9):3672-5. Epub 2007 Jan 5. link to original article contains dosing details in manuscript PubMed
SAKK 32/98: 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. link to original article contains dosing details in manuscript PubMed NCT00003746

Cladribine & Rituximab

Protocol

Study	Years of enrollment	Evidence
Ravandi et al. 2011	2004-2009	Phase 2

Chemotherapy

Cladribine (Leustatin) 5.6 mg/m² IV over 2 hours once per day on days 1 to 5

Supportive therapy

All were administered at the discretion of the treating physician.

5-day course 28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50

8-week course

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 dosing details in manuscript link to PMC article PubMed
1. Update: Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. link to original article link to PMC article PubMed

Pentostatin monotherapy

Regimen variant #1

Study	Years of enrollment	Evidence
Spiers et al. 1987	1984-1987	Non-randomized

Chemotherapy

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

Regimen variant #2

Study	Years of enrollment	Evidence	Comparator	Comparative Efficacy
Grever et al. 1995 (SWOG 8691)	1986-1989	Phase 3 (E-RT-switch-ooc)	Interferon alfa-2a	Superior RFS

Note: patients who had complete response before 6 months were given 2 additional cycles of pentostatin, and then treatment was stopped. Patients with objective partial response after 6 months of treatment received an additional 6 months of additional therapy, until they had a complete response or progression of disease.

Chemotherapy

Pentostatin (Nipent) 4 mg/m² IV rapid injection once on day 1
- Patients with performance status of 3 received an initial dose of 2 mg/m² IV rapid injection once on day 1, which would be increased in later cycles to 4 mg/m² IV rapid injection once on day 1 if patients had no adverse reactions.
- Doses of pentostatin were held for patients who had an increase in the serum creatinine concentration greater than 20% above their baseline. Pentostatin was not given until renal function returned to baseline or if 24-hour creatinine clearance was greater than 50 mL/min/1.73m².

Supportive therapy

1.5 liters of IV fluid hydration with every dose

14-day cycles (see note)

References

Spiers AS, Moore D, Cassileth PA, Harrington DP, Cummings FJ, Neiman RS, Bennett JM, O'Connell MJ; ECOG. Remissions in hairy-cell leukemia with pentostatin (2'-deoxycoformycin). N Engl J Med. 1987 Apr 2;316(14):825-30. link to original article contains dosing details in manuscript PubMed
1. Update: 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 dosing details in abstract PubMed
SWOG 8691: Grever M, Kopecky K, Foucar MK, Head D, Bennett JM, Hutchison RE, Corbett WE, Cassileth PA, Habermann T, Golomb H, Rai K, Eisenhauer E, Appelbaum F, Cheson BD. Randomized comparison of pentostatin versus interferon alfa-2a in previously untreated patients with hairy cell leukemia: an intergroup study. J Clin Oncol. 1995 Apr;13(4):974-82. link to original article contains dosing details in manuscript PubMed
1. Update: Flinn IW, Kopecky KJ, Foucar MK, Head D, Bennett JM, Hutchison R, Corbett W, Cassileth P, Habermann T, Golomb H, Rai K, Eisenhauer E, Appelbaum F, Cheson B, Grever MR. Long-term follow-up of remission duration, mortality, and second malignancies in hairy cell leukemia patients treated with pentostatin. Blood. 2000 Nov 1;96(9):2981-6. link to original article contains dosing details in manuscript PubMed

Relapsed or refractory

Bendamustine & Rituximab (BR)

BR: Bendamustine, Rituximab

Regimen

Study	Years of enrollment	Evidence
Burotto et al. 2013	NR	Pilot, <20 patients

Note: this was a dose-escalation study and the bendamustine dose was selected for further study based on absence of DLT.

Chemotherapy

Bendamustine 90 mg/m² IV once per day on days 1 & 2

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1 & 15

28-day cycle for 6 cycles

References

Burotto M, Stetler-Stevenson M, Arons E, Zhou H, Wilson W, Kreitman RJ. Bendamustine and rituximab in relapsed and refractory hairy cell leukemia. Clin Cancer Res. 2013 Nov 15;19(22):6313-21. Epub 2013 Oct 28. link to original article link to PMC article PubMed

Cladribine & Rituximab

Protocol

Study	Years of enrollment	Evidence
Ravandi et al. 2011	2004-2009	Phase 2, <20 pts in this cohort

Chemotherapy

Cladribine (Leustatin) 5.6 mg/m² IV over 2 hours once per day on days 1 to 5

Supportive therapy

All were administered at the discretion of the treating physician.

5-day course 28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50

8-week course

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 dosing details in manuscript link to PMC article PubMed
1. Update: Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. link to original article link to PMC article PubMed

Interferon alfa-2a monotherapy

Regimen

Study	Years of enrollment	Evidence
Quesada et al. 1986 (N2752)	1984-NR	Non-randomized (RT)

Note: This is of historic interest. It is not completely clear whether the cited study is the same as N2752, which is cited by the FDA in the package insert.

Immunotherapy

Interferon alfa-2a (Roferon-A)

References

N2752: Quesada JR, Hersh EM, Manning J, Reuben J, Keating M, Schnipper E, Itri L, Gutterman JU. Treatment of hairy cell leukemia with recombinant alpha-interferon. Blood. 1986 Aug;68(2):493-7. link to original article PubMed

Interferon alfa-2b monotherapy

Regimen

Study	Years of enrollment	Evidence
Quesada et al. 1984	NR	Pilot, <20 pts
Golomb et al. 1986	1983-1984	Non-randomized
Golomb et al. 1988	1985-1987	Non-randomized portion of RCT (RT)

Note: This is of historic interest. Most patients had previously undergone splenectomy.

Immunotherapy

Interferon alfa-2b (Intron-A)

References

Quesada JR, Reuben J, Manning JT, Hersh EM, Gutterman JU. Alpha interferon for induction of remission in hairy-cell leukemia. N Engl J Med. 1984 Jan 5;310(1):15-8. link to original article PubMed
Golomb HM, Jacobs A, Fefer A, Ozer H, Thompson J, Portlock C, Ratain M, Golde D, Vardiman J, Burke JS, Brady J, Bonnem E, Spiegel R. Alpha-2 interferon therapy of hairy-cell leukemia: a multicenter study of 64 patients. J Clin Oncol. 1986 Jun;4(6):900-5. link to original article PubMed
Golomb HM, Ratain MJ, Fefer A, Thompson J, Golde DW, Ozer H, Portlock C, Silber R, Rappeport J, Bonnem E, Spiegel R, Tensen L, Burke JS, Vardiman JW. Randomized study of the duration of treatment with interferon alfa-2B in patients with hairy cell leukemia. J Natl Cancer Inst. 1988 May 4;80(5):369-73. link to original article PubMed

Moxetumomab pasudotox monotherapy

Regimen

FDA-recommended dose

Study	Years of enrollment	Evidence
Kreitman et al. 2018 (Study 1053)	2013-2016	Phase 2 (RT)

Targeted therapy

Moxetumomab pasudotox (Lumoxiti) 0.04 mg/kg IV over 30 minutes once per day on days 1, 3, 5

28-day cycle for up to 6 cycles

References

Study 1053: Kreitman RJ, Dearden C, Zinzani PL, Delgado J, Karlin L, Robak T, Gladstone DE, le Coutre P, Dietrich S, Gotic M, Larratt L, Offner F, Schiller G, Swords R, Bacon L, Bocchia M, Bouabdallah K, Breems DA, Cortelezzi A, Dinner S, Doubek M, Gjertsen BT, Gobbi M, Hellmann A, Lepretre S, Maloisel F, Ravandi F, Rousselot P, Rummel M, Siddiqi T, Tadmor T, Troussard X, Yi CA, Saglio G, Roboz GJ, Balic K, Standifer N, He P, Marshall S, Wilson W, Pastan I, Yao NS, Giles F. Moxetumomab pasudotox in relapsed/refractory hairy cell leukemia. Leukemia. 2018 Aug;32(8):1768-1777. Epub 2018 Jul 20. link to original article link to PMC article contains dosing details in abstract PubMed NCT01829711
1. Update: Kreitman RJ, Dearden C, Zinzani PL, Delgado J, Robak T, le Coutre PD, Gjertsen BT, Troussard X, Roboz GJ, Karlin L, Gladstone DE, Kuptsova-Clarkson N, Liu S, Patel P, Rotolo F, Mitry E, Pastan I, Giles F; Study 1053 investigators. Moxetumomab pasudotox in heavily pre-treated patients with relapsed/refractory hairy cell leukemia (HCL): long-term follow-up from the pivotal trial. J Hematol Oncol. 2021 Feb 24;14(1):35. link to original article link to PMC article PubMed

Rituximab monotherapy

Regimen

Study	Years of enrollment	Evidence
Nieva et al. 2003	2000-2002	Phase 2

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22

Supportive therapy

Allopurinol (Zyloprim) 300 mg PO once per day on days 1 to 7

4-week course

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 dosing details in manuscript PubMed

Vemurafenib monotherapy

Regimen

Study	Years of enrollment	Evidence	Efficacy
Tiacci et al. 2015 (MSKCC 12-200)	2013-2015	Phase 2	ORR: 96-100%

Note: a pooled analysis of two phase 2 trials is reported; they have slightly different durations - please see original text for details.

Targeted therapy

Vemurafenib (Zelboraf) 960 mg PO twice per day

28-day cycle for up to 4 cycles (Italian trial) or 6 cycles (MSKCC 12-200)

References

MSKCC 12-200: Tiacci E, Park JH, De Carolis L, Chung SS, Broccoli A, Scott S, Zaja F, Devlin S, Pulsoni A, Chung YR, Cimminiello M, Kim E, Rossi D, Stone RM, Motta G, Saven A, Varettoni M, Altman JK, Anastasia A, Grever MR, Ambrosetti A, Rai KR, Fraticelli V, Lacouture ME, Carella AM, Levine RL, Leoni P, Rambaldi A, Falzetti F, Ascani S, Capponi M, Martelli MP, Park CY, Pileri SA, Rosen N, Foà R, Berger MF, Zinzani PL, Abdel-Wahab O, Falini B, Tallman MS. Targeting mutant BRAF in relapsed or refractory hairy-cell leukemia. N Engl J Med. 2015 Oct 29;373(18):1733-47. Epub 2015 Sep 9. link to original article contains dosing details in manuscript link to PMC article PubMed NCT01711632

Hairy cell leukemia variant (HCLv), all lines of therapy

Note: this is a distinct disease process from hairy cell leukemia, but will be included on this page for now given the similarities. We may create a dedicated page in the future.

Cladribine & Rituximab

Protocol

Study	Years of enrollment	Evidence
Ravandi et al. 2011	2004-2009	Phase 2, <20 pts in this cohort

Chemotherapy

Cladribine (Leustatin) 5.6 mg/m² IV over 2 hours once per day on days 1 to 5

Supportive therapy

All were administered at the discretion of the treating physician.

5-day course 28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:

Targeted therapy

Rituximab (Rituxan) 375 mg/m² IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50

8-week course

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 dosing details in manuscript link to PMC article PubMed
1. Update: Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. link to original article link to PMC article PubMed

@@ Line 13: / Line 13: @@
 ==ESMO==
 *'''2015:''' Robak et al. [https://www.esmo.org/Guidelines/Haematological-Malignancies/Hairy-Cell-Leukaemia Hairy cell leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up]
 ==Hairy Cell Leukemia Foundation==
 *'''2017:''' Grever et al. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5290982/ Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia]
 ==[https://www.nccn.org/ NCCN]==
 *[https://www.nccn.org/professionals/physician_gls/pdf/hairy_cell.pdf NCCN Guidelines - Hairy Cell Leukemia]
 =Untreated=
 ==Cladribine monotherapy {{#subobject:dbcbf4|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1, 0.09 mg/kg/day x 7 days {{#subobject:c4fe17|Variant=1}}===
 {| class="wikitable" style="width: 60%; text-align:center;"
@@ Line 34: / Line 31: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 0.09 mg/kg/day IV continuous infusion over 7 days, started on day 1 (total dose: 0.63 mg/kg)
 '''7-day course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2, 0.1 mg/kg/day x 7 days {{#subobject:c4fe60|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 54: / Line 52: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 0.1 mg/kg/day IV continuous infusion over 7 days, started on day 1 (total dose: 0.7 mg/kg)
 '''7-day course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #3, 0.12 mg/kg/day x 5 days {{#subobject:e3c2ec|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 80: / Line 79: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 0.12 mg/kg IV over 2 hours once per day on days 1 to 5
 '''5-day course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #4, 0.14 mg/kg/day x 5 days {{#subobject:8929f9|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 100: / Line 100: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 0.14 mg/kg SC once per day on days 1 to 5
 '''5-day course'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #5, 0.15 mg/kg/day x 5 days {{#subobject:44f9c0|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 116: / Line 117: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 0.15 mg/kg IV over 2 hours once per day on days 1 to 5
 '''5-day course'''
+</div></div>
 ===References===
 # Piro LD, Carrera CJ, Carson DA, Beutler E. Lasting remissions in hairy-cell leukemia induced by a single infusion of 2-chlorodeoxyadenosine. N Engl J Med. 1990 Apr 19;322(16):1117-21. [https://doi.org/10.1056/NEJM199004193221605 link to original article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/1969613 PubMed]
@@ Line 130: / Line 131: @@
 # Robak T, Jamroziak K, Gora-Tybor J, Blonski JZ, Kasznicki M, Dwilewicz-Trojaczek J, Wiater E, Zdunczyk A, Dybowicz J, Dmoszynska A, Wojtaszko M, Zdziarska B, Calbecka M, Kostyra A, Hellmann A, Lewandowski K, Stella-Holowiecka B, Sulek K, Gawronski K, Skotnicki AB, Nowak W, Zawilska K, Molendowicz-Portala L, Kloczko J, Sokolowski J, Warzocha K, Seferynska I, Ceglarek B, Konopka L; PALG. Cladribine in a weekly versus daily schedule for untreated active hairy cell leukemia: final report from the Polish Adult Leukemia Group (PALG) of a prospective, randomized, multicenter trial. Blood. 2007 May 1;109(9):3672-5. Epub 2007 Jan 5. [http://www.bloodjournal.org/content/109/9/3672.long link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/17209059 PubMed]
 # '''SAKK 32/98:''' 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. [https://doi.org/10.1080/10428190903131755 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/19672771 PubMed] NCT00003746
 ==Cladribine & Rituximab {{#subobject:2beb9d|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:668e5c|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 144: / Line 144: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 5.6 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 5
 ====Supportive therapy====
 ''All were administered at the discretion of the treating physician.''
@@ Line 153: / Line 153: @@
 *[[Fluconazole (Diflucan)]]
 *[[Filgrastim (Neupogen)]]
 '''5-day course'''
 ''28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:''
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50
 '''8-week course'''
+</div></div>
 ===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. [http://www.bloodjournal.org/content/118/14/3818.long link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081440/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21821712 PubMed]
 ## '''Update:''' Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. [https://doi.org/10.1111/bjh.14129 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396841/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27301277 PubMed]
 ==Pentostatin monotherapy {{#subobject:c911b3|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #1 {{#subobject:85a551|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 181: / Line 175: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Pentostatin (Nipent)]] 5 mg/m<sup>2</sup> IV over 2 minutes once per day on days 1 & 2
 '''14-day cycles, continued to the point of maximal response or treatment failure'''
+</div></div><br>
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen variant #2 {{#subobject:3c386e|Variant=1}}===
 {| class="wikitable sortable" style="width: 100%; text-align:center;"
@@ Line 202: / Line 197: @@
 |}
 ''Note: patients who had complete response before 6 months were given 2 additional cycles of pentostatin, and then treatment was stopped. Patients with objective partial response after 6 months of treatment received an additional 6 months of additional therapy, until they had a complete response or progression of disease.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Pentostatin (Nipent)]] 4 mg/m<sup>2</sup> IV rapid injection once on day 1
 **Patients with performance status of 3 received an initial dose of 2 mg/m<sup>2</sup> IV rapid injection once on day 1, which would be increased in later cycles to 4 mg/m<sup>2</sup> IV rapid injection once on day 1 if patients had no adverse reactions.
 **Doses of pentostatin were held for patients who had an increase in the serum creatinine concentration greater than 20% above their baseline. Pentostatin was not given until renal function returned to baseline or if 24-hour creatinine clearance was greater than 50 mL/min/1.73m<sup>2</sup>.
 ====Supportive therapy====
 *1.5 liters of IV fluid hydration with every dose
 '''14-day cycles (see note)'''
+</div></div>
 ===References===
 # Spiers AS, Moore D, Cassileth PA, Harrington DP, Cummings FJ, Neiman RS, Bennett JM, O'Connell MJ; ECOG. Remissions in hairy-cell leukemia with pentostatin (2'-deoxycoformycin). N Engl J Med. 1987 Apr 2;316(14):825-30. [https://doi.org/10.1056/NEJM198704023161401 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/2434850 PubMed]
@@ Line 217: / Line 211: @@
 # '''SWOG 8691:''' Grever M, Kopecky K, Foucar MK, Head D, Bennett JM, Hutchison RE, Corbett WE, Cassileth PA, Habermann T, Golomb H, Rai K, Eisenhauer E, Appelbaum F, Cheson BD. Randomized comparison of pentostatin versus interferon alfa-2a in previously untreated patients with hairy cell leukemia: an intergroup study. J Clin Oncol. 1995 Apr;13(4):974-82. [https://doi.org/10.1200/jco.1995.13.4.974 link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/7707126 PubMed]
 ## '''Update:''' Flinn IW, Kopecky KJ, Foucar MK, Head D, Bennett JM, Hutchison R, Corbett W, Cassileth P, Habermann T, Golomb H, Rai K, Eisenhauer E, Appelbaum F, Cheson B, Grever MR. Long-term follow-up of remission duration, mortality, and second malignancies in hairy cell leukemia patients treated with pentostatin. Blood. 2000 Nov 1;96(9):2981-6. [http://www.bloodjournal.org/content/96/9/2981.long link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/11049974 PubMed]
 =Relapsed or refractory=
 ==Bendamustine & Rituximab (BR) {{#subobject:3904a|Regimen=1}}==
 BR: '''<u>B</u>'''endamustine, '''<u>R</u>'''ituximab
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:98f0da|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 236: / Line 227: @@
 |}
 ''Note: this was a dose-escalation study and the bendamustine dose was selected for further study based on absence of DLT.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Bendamustine]] 90 mg/m<sup>2</sup> IV once per day on days 1 & 2
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1 & 15
 '''28-day cycle for 6 cycles'''
+</div></div>
 ===References===
 # Burotto M, Stetler-Stevenson M, Arons E, Zhou H, Wilson W, Kreitman RJ. Bendamustine and rituximab in relapsed and refractory hairy cell leukemia. Clin Cancer Res. 2013 Nov 15;19(22):6313-21. Epub 2013 Oct 28. [https://doi.org/10.1158/1078-0432.CCR-13-1848 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861900/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/24097860 PubMed]
 ==Cladribine & Rituximab {{#subobject:5f1038|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:821f7d|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 259: / Line 249: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 5.6 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 5
 ====Supportive therapy====
 ''All were administered at the discretion of the treating physician.''
@@ Line 268: / Line 258: @@
 *[[Fluconazole (Diflucan)]]
 *[[Filgrastim (Neupogen)]]
 '''5-day course'''
 ''28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:''
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50
 '''8-week course'''
+</div></div>
 ===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. [http://www.bloodjournal.org/content/118/14/3818.long link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081440/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21821712 PubMed]
 ## '''Update:''' Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. [https://doi.org/10.1111/bjh.14129 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396841/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27301277 PubMed]
 ==Interferon alfa-2a monotherapy {{#subobject:jgu3f0|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:3d3ig9|Variant=1}}===
 {| class="wikitable" style="width: 60%; text-align:center;"
@@ Line 295: / Line 280: @@
 |-
 |}
-''Of historic interest. It is not completely clear whether the cited study is the same as N2752, which is cited by the FDA in the package insert.''
+''Note: This is of historic interest. It is not completely clear whether the cited study is the same as N2752, which is cited by the FDA in the package insert.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Immunotherapy====
 *[[Interferon alfa-2a (Roferon-A)]]
+</div></div>
 ===References===
 #'''N2752:''' Quesada JR, Hersh EM, Manning J, Reuben J, Keating M, Schnipper E, Itri L, Gutterman JU. Treatment of hairy cell leukemia with recombinant alpha-interferon. Blood. 1986 Aug;68(2):493-7. [https://doi.org/10.1182/blood.V68.2.493.493 link to original article] [https://pubmed.ncbi.nlm.nih.gov/3730612/ PubMed]
 ==Interferon alfa-2b monotherapy {{#subobject:ca73f0|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:3d3149|Variant=1}}===
 {| class="wikitable" style="width: 60%; text-align:center;"
@@ Line 323: / Line 308: @@
 |-
 |}
-''Of historic interest. Most patients had previously undergone splenectomy.''
+''Note: This is of historic interest. Most patients had previously undergone splenectomy.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Immunotherapy====
 *[[Interferon alfa-2b (Intron-A)]]
+</div></div>
 ===References===
 # Quesada JR, Reuben J, Manning JT, Hersh EM, Gutterman JU. Alpha interferon for induction of remission in hairy-cell leukemia. N Engl J Med. 1984 Jan 5;310(1):15-8. [https://doi.org/10.1056/NEJM198401053100104 link to original article] [https://pubmed.ncbi.nlm.nih.gov/6689734 PubMed]
 # Golomb HM, Jacobs A, Fefer A, Ozer H, Thompson J, Portlock C, Ratain M, Golde D, Vardiman J, Burke JS, Brady J, Bonnem E, Spiegel R. Alpha-2 interferon therapy of hairy-cell leukemia: a multicenter study of 64 patients. J Clin Oncol. 1986 Jun;4(6):900-5. [https://doi.org/10.1200/JCO.1986.4.6.900 link to original article] [https://pubmed.ncbi.nlm.nih.gov/3519880 PubMed]
 # Golomb HM, Ratain MJ, Fefer A, Thompson J, Golde DW, Ozer H, Portlock C, Silber R, Rappeport J, Bonnem E, Spiegel R, Tensen L, Burke JS, Vardiman JW. Randomized study of the duration of treatment with interferon alfa-2B in patients with hairy cell leukemia. J Natl Cancer Inst. 1988 May 4;80(5):369-73. [https://academic.oup.com/jnci/article/80/5/369/997509 link to original article] [https://pubmed.ncbi.nlm.nih.gov/3282078 PubMed]
 ==Moxetumomab pasudotox monotherapy {{#subobject:06ef3f|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:3d2dea|Variant=1}}===
 {| class="wikitable" style="color:white; background-color:#404040"
@@ Line 349: / Line 334: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Moxetumomab pasudotox (Lumoxiti)]] 0.04 mg/kg IV over 30 minutes once per day on days 1, 3, 5
 '''28-day cycle for up to 6 cycles'''
+</div></div>
 ===References===
 # '''Study 1053:''' Kreitman RJ, Dearden C, Zinzani PL, Delgado J, Karlin L, Robak T, Gladstone DE, le Coutre P, Dietrich S, Gotic M, Larratt L, Offner F, Schiller G, Swords R, Bacon L, Bocchia M, Bouabdallah K, Breems DA, Cortelezzi A, Dinner S, Doubek M, Gjertsen BT, Gobbi M, Hellmann A, Lepretre S, Maloisel F, Ravandi F, Rousselot P, Rummel M, Siddiqi T, Tadmor T, Troussard X, Yi CA, Saglio G, Roboz GJ, Balic K, Standifer N, He P, Marshall S, Wilson W, Pastan I, Yao NS, Giles F. Moxetumomab pasudotox in relapsed/refractory hairy cell leukemia. Leukemia. 2018 Aug;32(8):1768-1777. Epub 2018 Jul 20. [https://doi.org/10.1038/s41375-018-0210-1 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc6087717/ link to PMC article] '''contains dosing details in abstract''' [https://pubmed.ncbi.nlm.nih.gov/30030507/ PubMed] NCT01829711
 ## '''Update:''' Kreitman RJ, Dearden C, Zinzani PL, Delgado J, Robak T, le Coutre PD, Gjertsen BT, Troussard X, Roboz GJ, Karlin L, Gladstone DE, Kuptsova-Clarkson N, Liu S, Patel P, Rotolo F, Mitry E, Pastan I, Giles F; Study 1053 investigators. Moxetumomab pasudotox in heavily pre-treated patients with relapsed/refractory hairy cell leukemia (HCL): long-term follow-up from the pivotal trial. J Hematol Oncol. 2021 Feb 24;14(1):35. [https://doi.org/10.1186/s13045-020-01004-y link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/pmc7905554/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/33627164/ PubMed]
 ==Rituximab monotherapy {{#subobject:9b852|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:929d4a|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 371: / Line 355: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22
 ====Supportive therapy====
 *[[Allopurinol (Zyloprim)]] 300 mg PO once per day on days 1 to 7
 '''4-week course'''
+</div></div>
 ===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. [http://www.bloodjournal.org/content/102/3/810.long link to original article] '''contains dosing details in manuscript''' [https://pubmed.ncbi.nlm.nih.gov/12663446 PubMed]
 ==Vemurafenib monotherapy {{#subobject:c957e9|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Regimen {{#subobject:5b6425|Variant=1}}===
 {| class="wikitable sortable" style="width: 80%; text-align:center;"
@@ Line 397: / Line 379: @@
 |-
 |}
+''Note: a pooled analysis of two phase 2 trials is reported; they have slightly different durations - please see original text for details.''
-''Note that a pooled analysis of two phase 2 trials is reported; they have slightly different durations - please see original text for details.''
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Targeted therapy====
 *[[Vemurafenib (Zelboraf)]] 960 mg PO twice per day
 '''28-day cycle for up to 4 cycles (Italian trial) or 6 cycles (MSKCC 12-200)'''
+</div></div>
 ===References===
 # '''MSKCC 12-200:''' Tiacci E, Park JH, De Carolis L, Chung SS, Broccoli A, Scott S, Zaja F, Devlin S, Pulsoni A, Chung YR, Cimminiello M, Kim E, Rossi D, Stone RM, Motta G, Saven A, Varettoni M, Altman JK, Anastasia A, Grever MR, Ambrosetti A, Rai KR, Fraticelli V, Lacouture ME, Carella AM, Levine RL, Leoni P, Rambaldi A, Falzetti F, Ascani S, Capponi M, Martelli MP, Park CY, Pileri SA, Rosen N, Foà R, Berger MF, Zinzani PL, Abdel-Wahab O, Falini B, Tallman MS. Targeting mutant BRAF in relapsed or refractory hairy-cell leukemia. N Engl J Med. 2015 Oct 29;373(18):1733-47. Epub 2015 Sep 9. [https://doi.org/10.1056/NEJMoa1506583 link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4811324/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/26352686 PubMed] NCT01711632
 =Hairy cell leukemia variant (HCLv), all lines of therapy=
 ''Note: this is a distinct disease process from hairy cell leukemia, but will be included on this page for now given the similarities. We may create a dedicated page in the future.''
 ==Cladribine & Rituximab {{#subobject:9989c5|Regimen=1}}==
+<div class="toccolours" style="background-color:#eeeeee">
 ===Protocol {{#subobject:e39d58|Variant=1}}===
 {| class="wikitable sortable" style="width: 60%; text-align:center;"
@@ Line 422: / Line 402: @@
 |-
 |}
+<div class="toccolours" style="background-color:#b3e2cd">
 ====Chemotherapy====
 *[[Cladribine (Leustatin)]] 5.6 mg/m<sup>2</sup> IV over 2 hours once per day on days 1 to 5
 ====Supportive therapy====
 ''All were administered at the discretion of the treating physician.''
@@ Line 431: / Line 411: @@
 *[[Fluconazole (Diflucan)]]
 *[[Filgrastim (Neupogen)]]
 '''5-day course'''
 ''28 days after administration of cladribine, bone marrow examination was repeated, and then rituximab was started:''
 ====Targeted therapy====
 *[[Rituximab (Rituxan)]] 375 mg/m<sup>2</sup> IV once per day on days 1, 8, 15, 22, 29, 36, 43, 50
 '''8-week course'''
+</div></div>
 ===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. [http://www.bloodjournal.org/content/118/14/3818.long link to original article] '''contains dosing details in manuscript''' [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4081440/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/21821712 PubMed]
 ## '''Update:''' Chihara D, Kantarjian H, O'Brien S, Jorgensen J, Pierce S, Faderl S, Ferrajoli A, Poku R, Jain P, Thompson P, Brandt M, Luthra R, Burger J, Keating M, Ravandi F. Long-term durable remission by cladribine followed by rituximab in patients with hairy cell leukaemia: update of a phase II trial. Br J Haematol. 2016 Sep;174(5):760-6. Epub 2016 Jun 15. [https://doi.org/10.1111/bjh.14129 link to original article] [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5396841/ link to PMC article] [https://pubmed.ncbi.nlm.nih.gov/27301277 PubMed]
 [[Category:Hairy cell leukemia regimens]]
 [[Category:Disease-specific pages]]
 [[Category:Indolent lymphomas]]

Difference between revisions of "Hairy cell leukemia"

Revision as of 17:16, 28 February 2023

Guidelines

ESMO

Hairy Cell Leukemia Foundation

NCCN

Untreated

Cladribine monotherapy

Regimen variant #1, 0.09 mg/kg/day x 7 days

Chemotherapy

Regimen variant #2, 0.1 mg/kg/day x 7 days

Chemotherapy

Regimen variant #3, 0.12 mg/kg/day x 5 days

Chemotherapy

Regimen variant #4, 0.14 mg/kg/day x 5 days

Chemotherapy

Regimen variant #5, 0.15 mg/kg/day x 5 days

Chemotherapy

References

Cladribine & Rituximab

Protocol

Chemotherapy

Supportive therapy

Targeted therapy

References

Pentostatin monotherapy

Regimen variant #1

Chemotherapy

Regimen variant #2

Chemotherapy

Supportive therapy

References

Relapsed or refractory

Bendamustine & Rituximab (BR)

Regimen

Chemotherapy

Targeted therapy

References

Cladribine & Rituximab

Protocol

Chemotherapy

Supportive therapy

Targeted therapy

References

Interferon alfa-2a monotherapy

Regimen

Immunotherapy

References

Interferon alfa-2b monotherapy

Regimen

Immunotherapy

References

Moxetumomab pasudotox monotherapy

Regimen

Targeted therapy

References

Rituximab monotherapy

Regimen

Targeted therapy

Supportive therapy

References

Vemurafenib monotherapy

Regimen

Targeted therapy

References

Hairy cell leukemia variant (HCLv), all lines of therapy

Cladribine & Rituximab

Protocol

Chemotherapy

Supportive therapy

Targeted therapy

References

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