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Clinical characteristics and long-term outcome of young hairy cell leukemia patients treated with cladribine: a single-institution series

Joshua D. Rosenberg, Carol Burian, Jill Waalen and Alan Saven

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Tables

  • Table 1

    Young HCL patient demographics at first treatment of cladribine

    No. of patients88
    Male/female63/25 (72%/28%)
    Age, y
     Median36 y
     Range20-40 y
    Prior therapy
     None42
     Splenectomy alone7
     Interferon alone17
     Splenectomy, interferon15
     Splenectomy, interferon, 2′-deoxycoformycin2
     Chlorambucil, splenectomy1
     Chlorambucil, interferon, splenectomy3
     Other regimens1
    Duration from diagnosis of HCL to the first cladribine course
     Median16 mo
     Range2 d to 470 mo
    Peripheral blood hematologic parameters
     Absolute neutrophil count (×109/L)
      Median (range)0.6 (0.1-2.7)
     White blood cell count (×109/L)
      Median (range)2.8 (0.3-30.3)
     Hemoglobin level (g/dL)
      Median (range)10.7 (3.2-16.1)
     Platelets (×109/L)
      Median (range)63 (11-136)
  • Table 2

    Young HCL patients at first relapse after receiving cladribine

    Number48
    Age
     Median (y)38
     Range31-55
    Sex
     Male36
     Female12
    Disease duration before cladribine
     Median (mo)15
     Range0-668
    Treatment before cladribine
     None29
     Splenectomy alone3
     Interferon alone6
     Splenectomy, interferon6
     Splenectomy, interferon, 2′-deoxycoformycin2
     Chlorambucil, splenectomy1
     Other regimens1
    First response to cladribine
     CR37
     PR8
     Unknown3
    Peripheral blood hematologic parameters at first relapse
     Absolute neutrophil count (×109/L)
      Median (range)1.4 (0.6-6.0)
     Hemoglobin level (g/dL)
      Median (range)14.2 (8.7-17.5)
     Platelets (×109/L)
      Median (range)135 (4-403)
     Duration to first relapse from cladribine therapy
      Median (mo)54
      Range7-246
    Treatment at relapse
      None11
      Cladribine31
      Rituximab5
      Cladribine + rituximab1
    Response to second course of cladribine (31 patients)
      CR12
      PR6
      CHR8
      No response1
      Unknown4
  • Table 3

    Second malignancies in young HCL patients after cladribine treatment

    PatientSecond cancerHCL therapy before cladribineAge (y) at diagnosis of second cancerTime (mo) from diagnosis of HCL to second cancerTime (mo) from cladribine to second cancerSurvival (mo) from diagnosis of HCLSurvival (mo) after diagnosis of second cancerStatus
    1Adenocarcinoma, colonSplenectomy531781284106Alive
    2Adenocarcinoma, prostateSplenectomy, interferon, chlorambucil6431412238571Dead
    2Adenocarcinoma, colonSplenectomy, interferon, chlorambucil6128189385104Dead
    2Adenocarcinoma, pancreasSplenectomy, interferon, chlorambucil6937518338511Dead
    3Non-Hodgkin lymphomaIFN, G-CSF6530123633737Alive
    4Metastatic renal cell carcinomaSplenectomy, IFN, chlorambucil, prednisone593532063541Dead
    5CMLNone49163136277115Alive
    5Non-Hodgkin lymphoma (follicular)None5422319627755Alive
    6Adenocarcinoma, prostateNone582432392441Alive
    7Acute myeloid leukemia – FAB M2IFN, prednisone60327633347Dead
    8Acute myeloid leukemiaSplenectomy, chlorambucil613952474027Dead
    • CML, chronic myelogenous leukemia; G-CSF, granulocyte colony-stimulating factor; IFN, interferon.

  • Table 4

    Clinical outcomes according to age at diagnosis of HCL

    ≤40 y of age (n = 88)All patients (n = 209)6
    Median age (range)36 y (20-40)50 y (28-79)
    Response rate100%100%
    Complete88%95%
    Partial12%5%
    Median response duration (mo)57 (range, 7-246 mo)98 (range, 8-172 mo)
    Relapse rate58%37%
    Median time to relapse (mo)54 (range, 7-246 mo)42 (range, 8-118 mo)
    Observed-to-expected ratio of developing a second malignancy1.60 (95% CI, 0.80-2.89)2.03 (95% CI, 1.49-2.71)
    • CI, confidence interval.