Difference between revisions of "Hairy cell leukemia"
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'''14-day cycles, continued to the point of maximal response or treatment failure''' | '''14-day cycles, continued to the point of maximal response or treatment failure''' | ||
| − | ===regimen 2 IW Flinn | + | ===regimen 2 IW Flinn et al 2000=== |
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Patients with an objective partial response can get further 6 months or until complete response or disease progression, | Patients with an objective partial response can get further 6 months or until complete response or disease progression, | ||
The initial pentostatin dose could be reduced based on performance status and subsequent doses could be reduced based on renal function''' | The initial pentostatin dose could be reduced based on performance status and subsequent doses could be reduced based on renal function''' | ||
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| + | supportive care: Hydration. | ||
===References=== | ===References=== | ||
Revision as of 04:36, 22 April 2014
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Untreated
Cladribine (Leustatin)
Regimen #1, Tallman et al. 1996
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)
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)
Phase III
- Cladribine (Leustatin) 0.14 mg/kg/day IV once per day on days 1, 8, 15, 22, 29
5-week course
Regimen #4, Damasio et al. 1998
Phase II
Cladribine (Leustatin) 0.15 mg/kg IV over 2 hours once daily for 5 consecutive days
One course
Regimen #5, Robak et al. 1999
Phase II
Cladribine (Leustatin) 0.12 mg/kg IV over 2 hours once daily for 5 consecutive days
One 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. link to original article contains protocol PubMed
- Damasio EE, Resegotti L, Masoudi B, et al: 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 89:68-73, 1998
- Robak T, Blasinska-Moraweic M, Blonski J, et al: 2′chlorodeoxyadenosine (caldribine) in the treatment of hairy cell leukemia and hairy cell leukemia variant: 7 year experience-Poland. Eur J Haematol 62:49-56, 1999
Cladribine & Rituximab
Regimen, Ravandi et al. 2011
Phase II
- Cladribine (Leustatin) 5.6 mg/m2 IV 2 hours daily for 5 days
Supportive medications: All were administered at the discretion of the treating physician
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
One 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 verified protocol PubMed
Pentostatin (Nipent)
Phase II
regimen 1
- 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 2 IW Flinn et al 2000
Phase III
- Pentostatin 4 mg/m2 by rapid intravenous injection
14 day cycles,patients who achieved a complete response before 6 months given 2 additional doses of pentostatin Patients with an objective partial response can get further 6 months or until complete response or disease progression, The initial pentostatin dose could be reduced based on performance status and subsequent doses could be reduced based on renal function
supportive care: Hydration.
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
- Flinn IW, Kopecky KJ, Foucar MK, et al: Long-term follow-up of remission duration, mortality, and second malignancies in hairy cell leukemia patients treated with pentostatin. Blood 96: 2981-2986, 2000 link to original artcle pubmed
- Grever M, Kopecky K, Foucar MK, et al. Randomized comparison of pentostatin versus interferon alfa-2a in previously untreated patients with hairy cell leukemia: an intergroup study.link to artcle pubmed
Relapsed/Refractory
BR
BR: Bendamustine, Rituximab
Regimen, Burotto et al. 2013
Pilot, <20 patients reported
- Rituximab (Rituxan) 375 mg/m2 IV once on days 1 & 15
- Bendamustine (Treanda) 70 or 90 mg/m2 IV once daily on days 1 & 2
28-day cycles x 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 Oct 28. [Epub ahead of print] link to original article PubMed
Rituximab (Rituxan)
Regimen, Nieva et al. Blood 2003
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 (Zyloprim) 300 mg PO once per day for the first 7 days of treatment
One 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 verified protocol PubMed