TÜYLÜ HÜCRELİ LÖSEMİ TANILI İKİ OLGUDA BİRİNCİ DİZİ VE NÜKSTE KLADRİBİN UYGULAMASI

Yıl 2011, Cilt: 74 Sayı: 4, 66 - 71, 08.02.2012

İpek Yönal Raif Coşkun Fehmi Hindilerden Erkan Özcan Öner Doğan Selim Yavuz Meliha Nalçacı

Öz

Tüylü hücreli lösemi (THL) birinci dizi ve nükste purin nükleozid analoğu olan kladribin (2-klorodeoksiadenozin) ile tedavi edilebilen nadir görülen kronik seyirli lenfoproliferatif hastalıktır. Bu yazıda THL tanısı ile kladribin uygulanarak tam remisyon (TR) elde edilmiş ve tanının 6. yılında nüks nedeniyle tekrar kladribin uygulanması sonrası 3. ayda kemik iliği biyopsisinde retikülin liflerinin kaybolduğu, tüylü lösemi hücrelerinin de saptanmadığı (tekrar TR elde edilen) bir olgu ve THL tanısı ile kladribin uygulanarak TR elde edilen, tanının 14. yılında nüks THL tanısıyla kladribin uygulanmasının 23. gününde nötropenik ateş, candida pnömonisi ve septik şok sonucu eks olan ikinci bir olgu bildirilmektedir.

Anahtar Kelimeler

Tüylü hücreli lösemi, nüks tüylü hücreli lösemi, kladribin (2-klorodeoksiadenozin)

Kaynakça

• Beutler E. Cladribine (2-chlorodeoxyadenosine). Department of Molecular and Experimental Medicine, Scripps Research Institute, La Jolla, California 92307. Lancet. 1992;340:952-956.
• Bouroncle, BA, Wiseman, BK, Doan, CA. Leukemic reticuloendotheliosis. Blood 1958; :609.
• Carson DA, Wasson DB, Kaye J, Ullman B, Martin DW Jr, Robins RK, Montgomery JA. Deoxycytidine deoxyadenosine analogs toward malignant human lymphoblasts in vitro and toward murine L1210 leukemia in vivo. Proc Natl Acad Sci U S A. ;77:6865-6869.
• Cohen A, Hirshhorn R, Horowitz SD, Rubinstein A, Polmar SH, Hong R, Martin DW Jr. Deoxyadenosine triphosphate as a potentially toxic metabolite in adenosine deaminase deficiency. Proc Natl Acad Sci U S A. 1978 ;75:472-476.
• Else M, Dearden CE, Matutes E, et al. Long-term follow-up of 228 hairy cell leukemia patients treated with pentostatin or cladribine with 15.4 years median time from diagnosis. Blood 112:731, Else M, Dearden CE, Matutes E, et al. Long-term follow-up of 233 patients with hairy cell leukaemia, treated initially with pentostatin or cladribine, at a median of 16 years from diagnosis. Br J Haematol 2009;145:733-740.
• Else M, Osuji N, Forconi F, et al. The role of rituximab in combination with pentostatin or cladribine for the treatment of recurrent/refractory hairy cell leukemia. Cancer 2007;110:2240-2247.
• Flandrin G, Sigaux F, Sebahoun G, Bouffette P. Hairy cell leukemia: clinical presentation and follow-up of 211 patients. Semin Oncol. 1984 :458-471.
• Giblett ER, Anderson JE, Cohen F, Pollara B, Meuwissen HJ. Adenosine deaminase deficiency in two patients with severely impaired cellular immunity. Lancet. 1972;2:1067-1079.
• Goodman GR, Burian C, Koziol JA, Saven A. Extended follow-up of patients with hairy cell leukemia after treatment with cladribine. J Clin Oncol. 2003;21:891-896.
• Grever MR. How I treat hairy cell leukemia. Blood. 2010 ;115:21-28.
• Groll AH, Walsh TJ. Invasive fungal infections in the neutropenic cancer patient. Abstr Hematol Oncol 2003; 6(1): 18-26. toxicity of
• Juliusson G, Christiansen I, Hansen MM, Johnson S, Kimby E, Elmhorn-Rosenborg A, Liliemark J. Oral cladribine as primary therapy for patients with B-cell chronic lymphocytic leukemia. J Clin Oncol. 1996 Jul;14(7):2160-6.
• Juliusson G, Heldal D, Hippe E, Hedenus M, Malm Juliusson G, Christiansen I, Hansen MM, Johnson S, Kimby E, Elmhorn-Rosenborg A, Liliemark J. Oral cladribine as primary therapy for patients with B-cell chronic lymphocytic leukemia. J Clin Oncol. 1996 ;14:2160-2166.
• Juliusson G, Heldal D, Hippe E, Hedenus M, Malm C, Wallman K, Stolt CM, Evensen SA, Albertioni F, et al. Subcutaneous injections of 2-chlorodeoxyadenosine for symptomatic hairy cell leukemia. J Clin Oncol. 1995 ;13:989-995.
• Juliusson G, Liliemark J. Purine analogues: rationale for development, pharmacokinetics in hairy cell leukemia. Hematol Oncol Clin North Am. 2006;20:1087–1097.
• Labouyrie E, Marit G, Vial JP, Lacombe F, Fialon P, Bernard P, de Mascarel A, Merlio JP. Intrasinusoidal bone marrow involvement by splenic lymphoma with villous lymphocytes: a helpful immunohistologic feature. Mod Pathol. 1997;10:1015-1020.
• Lauria F, Bocchia M, Marotta G, Raspadori D, Zinzani PL, Rondelli D. Weekly administration of 2- chlorodeoxyadenosine leukemia complications. Haematologica. 1999;84:22–25.
• 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 ;322:1117-1121. of action, and in patients and infectious is effective reduces
• Robak T, Jamroziak K, Gora-Tybor J, et al. 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. ;109:3672-3675.
• Saven A, Burian C, Koziol JA, Piro LD. Long-term follow-up of patients with hairy cell leukemia after cladribine treatment. Blood. 1998 ;92:1918-1926.
• Schrek R, Donnelly WJ. "Hairy" cells in blood in lymphoreticular neoplastic disease and "flagellated" cells of normal lymph nodes. Blood. 1966 ;27:199
• Seymour JF, Kurzrock R, Freireich EJ, Estey EH. 2- chlorodeoxyadenosine induces durable remissions and prolonged suppression of CD4+ lymphocyte counts in patients with hairy cell leukemia. Blood. ;83:2906-2911.
• Spiers AS, Parekh SJ, Bishop MB. Hairy-cell leukemia: induction of complete remission with pentostatin (2'-deoxycoformycin). J Clin Oncol. ;2:1336-1342.
• Zinzani PL, Tani M, Marchi E, et al. Long-term follow-up of front-line treatment of hairy cell leukemia Haematologica. 2004;89:309–313. chlorodeoxyadenosine.
• İstanbul Tıp Fakültesi Dergisi Cilt / Volume: 71 • Sayı / Number: 4 • Yıl/Year: 2011