Patients with hairy cell leukemia can have a long-term complete hematologic response after a one-week course of cladribine, a cytotoxic chemotherapy.
Researchers searched the Scripps Clinic cladribine hairy cell leukemia computer database for patients who were alive and in continuous complete hematologic remission after being treated with a single seven-day course of cladribine for hairy cell leukemia. They wanted to identify whether those patients assigned cladribine with long-term response had no minimal residual disease.
They identified 19 patients who had evaluable bone marrow tissue specimens. Patients received cladribine as a seven-day continuous IV infusion at 0.085 mg/kg per day to 0.1 mg/kg per day. The median time from diagnosis was 18 years.
All patients underwent biopsy and a bone marrow aspiration. Researchers performed CD20 immunostaining on all samples to identify cells characteristic of hairy cell leukemia and quantify residual disease as a percentage of marrow cellularity.
At a median follow-up of 16 years, nine patients (47%) appeared to have no evidence of residual disease. Of the 53% of patients with residual disease, seven (37%) had minimal residual disease and three (16%) had morphologic disease.
“While not as sensitive as clone-specific [polymerase chain reaction], the negative assays of two tests that are still highly sensitive coupled with very extended follow-up of these patients raises the possibility that a single course of cladribine can potentially cure [hairy cell leukemia],” the researchers wrote. “However, declaring cures in low-grade lymphoproliferative disorders must always be done cautiously, as very late relapses are known to occur.”
Sigal DS. Blood. 2010;doi:10.1128/blood-2009-10-251645.
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