Subcutaneous and Intravenous Cladribine Treatment of Hairy Cell Leukemia Patients: Do We Still Need Intravenous Cladribine?

Year 2023, , 109 - 116, 29.04.2023

Tuba Ersal , Fahir Özkalemkaş , Vildan Ozkocaman , İbrahim Ethem Pınar , Cumali Yalçın , Bedrettin Orhan , Ömer Candar , Sinem Çubukçu , Tuba Güllü Koca , Rıdvan Ali

https://doi.org/10.46310/tjim.1239905

Abstract

Background Hairy cell leukemia (HCL) is an uncommon neoplasm representing approximately 2% leukemias and <1% lymphoid neoplasms. Although HCL remains an incurable disease, first-line treatment with intravenous (IV) or subcutaneous (SC) cladribine (2-CdA) often leads to long-term remissions. Although long-term data are available for IV administration, similar comparable data for SC administration are lacking.
Material and Methods Demographic data, laboratory and clinical parameters of 20 patients with HCL, and IV and SC administrations of cladribine in primary treatment were analyzed.
Results All patients were administered 2-CdA as the first-line therapy. 2-CdA was administered intravenously to 11 patients and subcutaneously to 9 patients. The hospitalization times were shorter in the SC route, and the incidence of febrile neutropenia was less; therefore, statistical significance could not be determined. There was no difference between the route of administration and the treatment response. A correlation was recorded between the level of anemia before treatment and the time to treatment response. In addition, a correlation was recorded between the level of anemia before treatment and minimal residual disease status after treatment. The median overall survival (OS) was 43.5 months (confidence interval 95%: 1.5-79 months), and 2- and 5-year OS was 95%. There was no increase in the incidence of second primary cancer.
Conclusions The outcomes of HCL patients treated with SC 2-CdA are quite good, and, in most patients, one cycle of SC 2-CdA was adequate for long-term disease control. SC 2-CdA is an easily applicable option for outpatients, and their side effects are often easily manageable.

Keywords

hairy cell leukemia, 2-chlorodeoxyadenosine, 2-CdA, subcutaneous cladribine

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