Treatment of Hairy Cell Leukemia During Pregnancy: Are Purine Analogues and Rituximab Viable Therapeutic Options

Daver, Naval; Nazha, Aziz; Kantarjian, Hagop M.; Haltom, Rodney; Ravandi, Farhad

doi:10.1016/j.clml.2012.06.009

Cited by 22 publications

(12 citation statements)

References 29 publications

(26 reference statements)

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“…Specific situations where splenectomy may be considered are after non‐traumatic rupture, which is a very rare complication in HCL (Gedik et al , ) or for truly refractory disease (Habermann & Rai, ) in the latter case, we would exhaust clinical trial options of systemic therapy prior to resorting to splenectomy. Splenectomy has been used to treat pregnant women to delay chemotherapy administration; HCL in pregnant women requiring treatment is a rare situation; management decisions are complex and reviewed elsewhere (Daver et al , ).…”

Section: First Line Therapymentioning

confidence: 99%

How I manage patients with hairy cell leukaemia

Thompson

Ravandi

2017

Br J Haematol

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Patients with hairy cell leukaemia (HCL) have highly favourable outcomes after purine analogue therapy. However, most patients subsequently relapse and require re-treatment. A minority of patients develop purine analogue-refractory disease. Targeted therapies have improved outcomes for such patients. Recently, the BRAF V600E mutation was identified in most patients with classical HCL, resulting in constitutive mitogen-activated protein kinase pathway activation; impressive responses are achieved in heavily pre-treated patients with BRAF inhibition. The CD22-targeted immunoconjugate moxetumomab pasudotox and BTK inhibitor ibrutinib also achieve responses in relapsed and refractory patients. HCL variant and the IGHV4-34 molecular variant of HCL lack BRAF mutation and have inferior outcomes with standard purine analogue therapy. The addition of rituximab to purine analogues achieves very high rates of minimal residual disease-negative complete remission and improves outcomes for patients with HCL variant. Given the rarity of HCL, optimal integration of novel therapies into treatment algorithms will require well-designed, collaborative studies.

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Section: First Line Therapymentioning

confidence: 99%

How I manage patients with hairy cell leukaemia

Thompson

Ravandi

2017

Br J Haematol

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“…In this respect the London Position Statement of the World Congress of Gastroenterology on the Biological Therapy for IBD stated that vaccination of infants exposed to biological therapy in utero should be given according standard schedules, except for live-virus vaccines, which are not recommended if biological agents are detectable in the infant bloodstream (71). Table III summaries the reports of maternal exposure to rituximab either prior to or during pregnancy (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). Rituximab has various indications.…”

Section: Anti-tnfαmentioning

confidence: 99%

Are biological drugs safe in pregnancy?

et al. 2015

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The introduction of biological therapies has significantly improved the outcome of inflammatory rheumatic diseases. As most of these diseases affect women and men in childbearing age, some concerns have been voiced as to the safety of these drugs in relation to reproduction and pregnancy. Data from many hundreds of pregnancies in patients affected by inflammatory bowel disease and inflammatory arthritis have suggested that exposure to anti-TNF therapies at conception and/or during pregnancy is not associated with adverse pregnancy outcomes or any increase in congenital abnormalities. However, the exposure to anti-TNFα agents, particularly to monoclonal antibodies, in late pregnancy is associated with high drug levels in the newborn and their long-term effects on children remain unknown. Therefore, limiting the use of anti-TNFα to the first 30 weeks of pregnancy is recommended to reduce fetal exposure. Live-virus vaccines should be given only when levels of anti-TNFα drugs are undetectable in the serum of infants. Studies suggest that many of these drugs do enter breast milk in small amounts, but the extent to which the infant absorbs them is less clear. Limited reports have not suggested adverse pregnancy outcomes in women whose partners were exposed to anti-TNF therapies at the time of conception. Pregnancy data for rituximab, abatacept, anakinra, tocilizumab and belimumab are limited and their use in pregnancy cannot currently be recommended.

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“…Fewer than 10 cases have been reported. 90,91 Hairy cell leukemia can be complicated by significant splenomegaly, and treatment options have traditionally included splenectomy and single-agent 2-chlorodeoxyadenosine (cladrabine). If possible, it is preferable to defer treatment until after delivery.…”

Section: Hairy Cell Leukemiamentioning

confidence: 99%

How I treat leukemia during pregnancy

Milojković

Apperley

2014

Blood

123

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Leukemia in pregnancy remains a challenging therapeutic prospect. The prevalence is low at ∼1 in 10 000 pregnancies, and as a result data are limited to small retrospective series and case reports, rendering evidence-based recommendations for management strategies difficult. The management of the leukemias in pregnancy requires close collaboration with obstetric and neonatology colleagues as both the maternal and fetal outcomes must be taken into consideration. The decision to introduce or delay chemotherapy must be balanced against the impact on maternal and fetal survival and morbidity. Invariably, acute leukemia diagnosed in the first trimester necessitates intensive chemotherapy that is likely to induce fetal malformations. As delaying treatment in this situation is usually inappropriate, counseling with regard to termination of pregnancy is often essential.For chronic disease and acute leukemia diagnosed after the second trimester, therapeutic termination of the pregnancy is not inevitable and often, standard management approaches similar to those in nongravid patients can be used. Here, the management of the acute and chronic leukemias will be addressed. (Blood. 2014;123(7):974-984)

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Treatment of Hairy Cell Leukemia During Pregnancy: Are Purine Analogues and Rituximab Viable Therapeutic Options

Cited by 22 publications

References 29 publications

How I manage patients with hairy cell leukaemia

How I manage patients with hairy cell leukaemia

Are biological drugs safe in pregnancy?

How I treat leukemia during pregnancy

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