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

Article Article scientifique Article Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial eng 2020 author Benz Rudolf author Arn Kornelius 931302 author Andres Martin author Pabst Thomas author Baumann Michael author Novak Urban author Hitz Felicitas author Hess Urs author Zenhaeusern Reinhard author Chalandon Yves 644957 author Mey Ulrich author Blum Sabine author Rauch Daniel author O'Meara Stern Alix author Cantoni Nathan author Bargetzi Mario author Bianchi-Papina Elena author Rossi Davide author Passweg Jakob 632725 author Lohri Andreas author Berardi Simona author Li Qiyu author Feller Anita author Stussi Georg 3699-3707 10.1182/bloodadvances.2020002160 32777066 2473-9529 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7422123/ 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. Cancer Cladribine Follow-up Hairy-cell leukemia Retreatments Rituximab Disease remission Dewey 616 56 Département de médecine 221 false 1216 Leucémie et transplantation allogénique de cellules souches hématopoïétiques 982 Blood Advances 4 15 554c6d16-3e84-44a4-84b2-d875e10cfd82 Article (Published version) Public advancesADV2020002160.pdf 929210 application/pdf d0d4cebd-5bbb-432e-85ce-bae2fb06b761 Supplemental data Public advancesADV2020002160-suppl1.pdf 108363 application/pdf openAccess Faculté de médecine / Section de médecine clinique / Département de médecine

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Prospective long-term follow-up after first-line subcutaneous cladribine in hairy cell leukemia: a SAKK trial	Blood Advances			2020	291	205

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Arn, Kornelius