Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial.

Benz, Rudolf; Arn, Kornelius; Andres, Martin; Pabst, Thomas; Baumann, Michael; Novak, Urban; Hitz, Felicitas; Hess, Urs; Zenhaeusern, Reinhard; Chalandon, Yves; Mey, Ulrich; Blum, Sabine; Rauch, Daniel; O'Meara Stern, Alix; Cantoni, Nathan; Bargetzi, Mario; Bianchi-Papina, Elena; Rossi, Davide; Passweg, Jakob; Lohri, Andreas; ... (2020). Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial. Blood advances, 4(15), pp. 3699-3707. American Society of Hematology 10.1182/bloodadvances.2020002160

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Hairy cell leukemia (HCL) remains an incurable disease. However, first-line treatment with either intravenous or subcutaneous cladribine generally leads to long-lasting remissions. Although there are excellent long-term data for intravenous application, similar data regarding subcutaneous administration are lacking. We therefore analyzed the long-term outcome of 3 prospective multicenter clinical trials on subcutaneous cladribine performed by the Swiss Group for Clinical Cancer Research (SAKK), which recruited 221 patients with classical HCL between 1993 and 2005. Median overall survival from start of treatment was not reached. Pretreatment anemia, higher Eastern Cooperative Oncology Group score, and higher age were associated with poorer overall survival in multivariable analysis, whereas early progression at 24 and 36 months had no significant impact on overall survival. Second-line treatment was necessary in 53 (23.7%) patients after a median of 5 (range, 0.2-20.4) years, and first retreatment was mainly monotherapy with cladribine (66%) or rituximab (15.1%) or a combination of these drugs (15.1%). A total of 44 (19.9%) patients developed second primary malignancies with a median time to occurrence of 5.7 (range, 0.01-17.5) years. Second primary malignancies were the main cause for death (14; 27.5%). Compared with a matched normal Swiss population, the incidence of second primary malignancies was not increased. However, survival of patients with HCL was slightly inferior by comparison (P = .036). In conclusion, the outcome of HCL patients treated with subcutaneous cladribine is excellent, and in most patients, 1 cycle of subcutaneous cladribine is sufficient for long-term disease control.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Haematology and Central Haematological Laboratory
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology

UniBE Contributor:

Andres, Martin; Pabst Müller, Thomas Niklaus; Novak, Urban and Rauch, Daniel

Subjects:

600 Technology > 610 Medicine & health

ISSN:

2473-9529

Publisher:

American Society of Hematology

Language:

English

Submitter:

Rebeka Gerber

Date Deposited:

24 Sep 2020 10:58

Last Modified:

24 Sep 2020 10:58

Publisher DOI:

10.1182/bloodadvances.2020002160

PubMed ID:

32777066

BORIS DOI:

10.7892/boris.146650

URI:

https://boris.unibe.ch/id/eprint/146650

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