Hairy cell leukemia

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8 regimens on this page
13 variants on this page


Guidelines

Hairy Cell Leukemia Foundation

NCCN

Untreated

Cladribine monotherapy

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Regimen #1

Study Evidence
Tallman et al. 1996 Phase II

Chemotherapy

7-day course

Regimen #2

Study Evidence Comparator Efficacy
Zenhäusern et al. 2009 (SAKK 32/98) Phase III Weekly Cladribine Seems not superior

Chemotherapy

5-day course

Regimen #3

Study Evidence Comparator Efficacy
Zenhäusern et al. 2009 (SAKK 32/98) Phase III Daily Cladribine Seems not superior

Chemotherapy

5-week course

Regimen #4

Study Evidence
Damasio et al. 1998 Phase II

Chemotherapy

Cladribine (Leustatin) 0.15 mg/kg IV over 2 hours once per day for 5 consecutive days

One course

Regimen #5

Study Evidence
Robak et al. 1999 Phase II

Chemotherapy

Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once per day for 5 consecutive days

One course

References

  1. 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
    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 protocol PubMed content property of HemOnc.org
  2. Damasio EE, Resegotti L, Masoudi B, Bruni R, Cerri R, Isaza A, Clavio M, Risso M, Rossi E, Spriano M, Truini M. 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
  3. 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. PubMed
  4. 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 protocol PubMed

Cladribine & Rituximab

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Regimen

Study Evidence
Ravandi et al. 2011 Phase II

Chemotherapy, part 1

Supportive medications

All were administered at the discretion of the treating physician.

One course

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

Chemotherapy, part 2

One course

References

  1. 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 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

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Regimen #1

Study Evidence
Cassileth et al. 1991 Phase II

Chemotherapy

14-day cycles, continued to the point of maximal response or treatment failure

Regimen #2

Study Evidence Comparator Efficacy
Grever et al. 1995 Phase III Interferon alfa-2a Superior RFS

Chemotherapy

  • Pentostatin (Nipent) 4 mg/m2 IV rapid injection once on day 1
    • Grever et al. 1995: 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.
    • Grever et al. 1995: 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 medications

  • 1.5 liters of IV fluid hydration with every dose

14 day cycles; 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.

References

  1. 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
  2. Grever M, Kopecky K, Foucar MK, Head D, Bennett JM, Hutchison RE, Corbett WE, Cassileth PA, Habermann T, Golomb H, et al. 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 verified protocol 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 verified protocol PubMed

Relapsed or refractory

BR

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BR: Bendamustine, Rituximab

Regimen

Study Evidence
Burotto et al. 2013 Pilot, <20 patients

Chemotherapy

28-day cycle for 6 cycles

References

  1. 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

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Regimen

Study Evidence
Ravandi et al. 2011 Phase II, <20 pts in this cohort

Chemotherapy, part 1

Supportive medications

All were administered at the discretion of the treating physician.

One course

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

Chemotherapy, part 2

One course

References

  1. 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 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

Rituximab monotherapy

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Regimen

Study Evidence
Nieva et al. 2003 Phase II

Chemotherapy

  • Rituximab (Rituxan) 375 mg/m2 IV once per week 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

One 4-week course

References

  1. 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

Vemurafenib monotherapy

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Regimen

Study Evidence
Tiacci et al. 2015 Phase II

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

Chemotherapy

Up to 16 weeks (Italian trial) or 24 weeks (U.S. trial)

References

  1. 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 verified protocol link to PMC article PubMed

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

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Regimen

Study Evidence
Ravandi et al. 2011 Phase II, <20 pts in this cohort

Chemotherapy, part 1

Supportive medications

All were administered at the discretion of the treating physician.

One course

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

Chemotherapy, part 2

One course

References

  1. 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 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