Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases.
Fiche publication
Date publication
janvier 2015
Journal
Annals of hematology
Auteurs
Membres identifiés du Cancéropôle Est :
Pr DELMER Alain
Tous les auteurs :
Leclerc M, Suarez F, Noël MP, Vekhoff A, Troussard X, Claisse JF, Thieblemont C, Maloisel F, Beguin Y, Tamburini J, Barbe C, Delmer A
Lien Pubmed
Résumé
The purine analogs (PAs) cladribine and pentostatin have transformed the prognosis of hairy cell leukemia (HCL). However, some patients still relapse after PAs, or fail to reach an optimal response, and new agents are needed to further improve treatment outcome. We retrospectively studied 41 HCL patients from 10 centers in France and Belgium, who received 49 treatment courses with the anti-CD20 monoclonal antibody rituximab. Most of the patients were treated at relapse (84 % of cases) and rituximab was combined to a PA in 41 % of cases. Overall, response rate is 90 % including 71 % complete hematologic responses (CHRs). Frontline treatment, combination therapy, and absolute neutrophil count were associated with response in multivariate analysis. Three-year relapse-free and overall survivals are 68 and 90 %, respectively. When combined to a PA, rituximab yields a 100 % response rate, even beyond frontline therapy. In contrast, response rate is only 82 % (59 % CHR) when rituximab is used alone. In this latter setting, relapse rate is 56 % and median time to relapse is 17.5 months. All eight patients who were treated two times with the antibody responded again to re-treatment. We confirm the high efficacy of the combination rituximab + PA. However, when rituximab is used as monotherapy, response rate is lower and the high relapse rate is a concern. Prospective clinical trials are needed to confirm the superiority of the combination rituximab + PA over PA alone, both as frontline therapy and at relapse.
Mots clés
Adult, Aged, Aged, 80 and over, Antibodies, Monoclonal, Murine-Derived, administration & dosage, Antineoplastic Agents, administration & dosage, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Leukemia, Hairy Cell, diagnosis, Male, Middle Aged, Retrospective Studies, Rituximab, Treatment Outcome
Référence
Ann. Hematol.. 2015 Jan;94(1):89-95