Effective Treatment of a Refractory Hairy Cell Leukemia Variant with Splenic Pre-Irradiation and Alemtuzumab

Sasaki, Makoto; Sugimoto, Koichi; Mori, Takeshi; Karasawa, Kumiko; Oshimi, Kazuo

doi:10.1159/000115785

Cited by 17 publications

(11 citation statements)

References 41 publications

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“…Rituximab alone or combined with other modalities was reported to induce complete or partial remission in several case reports [30,31,32]. Sasaki et al [33] reported an HCL-V patient who had partial remission after treatment with alemtuzumab following splenic irradiation. Complete remission after treatment with BL-22 (anti-CD22 immunotoxin) was reported in 3 patients refractory to 2-CDA by Kreitman et al [34].…”

Section: Discussionmentioning

confidence: 99%

Classical Hairy Cell Leukemia and Its Variant: A 17-Year Retrospective Survey in Taiwan Chinese

Kao

Dunn²,

Kuo³

et al. 2011

Acta Haematol

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Background: Classical hairy cell leukemia (HCL-C) and its variant (HCL-V) are rare chronic B-cell lymphoproliferative disorders. Only a few reports in Chinese patients are available. Methods: We retrospectively reviewed 16 patients with HCL-C and HCL-V in Taiwan over a 17-year period. Results: Eight were HCL-C and 8 were HCL-V. All HCL accounted for 0.7% of all adult leukemias. Compared to HCL-V, HCL-C was characterized by profound leukopenia, monocytopenia, thrombocytopenia and fewer circulating hairy cells. One HCL-C and 2 HCL-V patients had second malignancies. Seven HCL-C patients achieved hematological remission after splenectomy (n = 1) or 2-chlorodeoxyadenosine (n = 6). Of the 8 HCL-V patients, 6 received splenic irradiation. Only one achieved complete remission and another had partial remission; relapse or disease progression was noted 13.4 or 25.7 months later, respectively. Two of three HCL-V patients who underwent splenectomy had stable disease. All patients with HCL-C were alive while 3 with HCL-V expired. Compared to HCL-C, HCL-V had a significantly shorter leukemia-free survival. Conclusion: A relatively higher proportion of HCL-V in all HCL comparing to Westerners is observed. Second malignancies are common. With an inferior outcome and dismal response to most treatment, enrollment in a clinical trial should be considered for HCL-V.

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Section: Discussionmentioning

confidence: 99%

Classical Hairy Cell Leukemia and Its Variant: A 17-Year Retrospective Survey in Taiwan Chinese

Kao

Dunn²,

Kuo³

et al. 2011

Acta Haematol

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“…Alemtuzumab is a fully humanized monoclonal antibody against CD 52. Although attempts to treat HCL using anti-CD52 revealed limited success, there has been better response with treating refractory cases [16]. Its toxicity includes infusion reactions similar to rituximab and prolonged immunosuppression, leading to opportunistic infections.…”

Section: Anti-cd52 Antibody: Alemtuzumabmentioning

confidence: 99%

Advances in the Treatment of Hairy Cell Leukemia

Alsara¹,

Amaraneni²,

Sreenivasa³

et al. 2015

J Hematol Thrombo Dis

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Hairy cell leukemia is relatively rare, chronic low grade B-cell leukemia. It is characterized morphologically by cells with abundant cytoplasm and "hair"-like projections that can be found within the peripheral blood, bone marrow or splenic pulp. Like many cancers, the treatment for hairy cell leukemia has evolved considerably in the last several years. In the mid 1980s, the acceptable treatment was splenectomy and later interferon therapy, which is quickly falling out of favor with the advent and acceptance of purine analog therapy. In addition, we now have several biologic agents that are coming into favor based on their improved success and favorable toxicity. In addition, several studies are currently looking into the efficacy of purine analogs in conjunction with biologic agents. Rituximab, alemtuzumab and recombinant immunotoxins are being studied with limited success in hairy cell leukemia. The use of kinase inhibition is also being studied at this time. Advances in understanding the biology of hairy cell leukemia could potentially increase more treatment options.

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“…In the largest study on treatment in HCL-variant, splenectomy yielded clinical responses in 74% of patients (13/19) lasting for greater than 8 years in a proportion of patients [53]. An alternative approach in patients with surgical risk and poor performance status is splenic irradiation which may result in PR in around half of the patients [53,55] or may facilitate further treatment [56]. IFN-α has no role in the therapeutic scenario of HCL-variant as nearly all patients will be resistant to this drug unlike typical HCL [57].…”

Section: Treatmentmentioning

confidence: 99%

“…Alemtuzumab, the humanised anti-CD52 McAb is an attractive agent to be used in this disease on the basis that its activity is mainly seen in the spleen and bone marrow and it has been shown to be effective in CLL with TP53 abnormalities. So far, two cases have been reported successfully treated with either alemtuzumab as single agent or using alemtuzumab after splenic irradiation [56,63]. Further data on the use of alemtuzumab in HCLvariant is needed to confirm its activity.…”

Section: Treatmentmentioning

confidence: 99%

Novel and Emerging Drugs for Rarer Chronic Lymphoid Leukaemias

Matutes¹

2012

CCDT

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Rarer chronic lymphoid leukaemias represent a challenge to the clinicians due to the limited information on their pathogenesis, difficulties on setting up prospective clinical trials and to their refractoriness to drugs used in the most common form of chronic lymphocytic leukaemia (CLL). In this review all these issues are addressed in three B-cell leukaemias: B-cell prolymphocytic leukaemia (B-PLL), hairy cell leukaemia (HCL) and HCL-variant and three T-cell leukaemias: T-cell prolymphocytic leukaemia (T-PLL), T-cell large granular lymphocytic leukaemia (T-cell LGLL) and adult T-cell leukaemia lymphoma (ATLL). Data will be presented on the natural history, current therapies and emerging drugs potentially useful in the treatment of patients with these leukaemias. Emphasis is made on: 1- the novel agents targeting a variety of B and T-cell antigens expressed on the surface of the leukaemic cells; these are either unconjugated monoclonal antibodies (McAb) such as Rituximab (anti-CD20), the second and third generation of anti-CD20 McAbs, Alemtuzumab (anti-CD52), Siplizumab (anti-CD2), Daclizumab (anti-CD25) and KW-0761, an anti-chemokine receptor 4 (CCR4) or McAbs conjugated to toxins such as CD22 linked to the pseudomonas exotoxin or radiolabelled McAb; 2- the use of new purine nucleosides such as nelarabine and 3- agents targeting deregulated genes in the leukaemic cells from these diseases such as the Poly (ADP-ribose) polymerase (PARP) Olarapib in T-PLL with deregulation of the ataxia telangiectasia mutated (ATM) gene. Data of phase I and II clinical studies with these agents as well as the potential and current use of other drugs are outlined.

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Effective Treatment of a Refractory Hairy Cell Leukemia Variant with Splenic Pre-Irradiation and Alemtuzumab

Cited by 17 publications

References 41 publications

Classical Hairy Cell Leukemia and Its Variant: A 17-Year Retrospective Survey in Taiwan Chinese

Classical Hairy Cell Leukemia and Its Variant: A 17-Year Retrospective Survey in Taiwan Chinese

Advances in the Treatment of Hairy Cell Leukemia

Novel and Emerging Drugs for Rarer Chronic Lymphoid Leukaemias

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