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Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases

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Abstract

The purine analogs (PAs) cladribine and pentostatin have transformed the prognosis of hairy cell leukemia (HCL). However, some patients still relapse after PAs, or fail to reach an optimal response, and new agents are needed to further improve treatment outcome. We retrospectively studied 41 HCL patients from 10 centers in France and Belgium, who received 49 treatment courses with the anti-CD20 monoclonal antibody rituximab. Most of the patients were treated at relapse (84 % of cases) and rituximab was combined to a PA in 41 % of cases. Overall, response rate is 90 % including 71 % complete hematologic responses (CHRs). Frontline treatment, combination therapy, and absolute neutrophil count were associated with response in multivariate analysis. Three-year relapse-free and overall survivals are 68 and 90 %, respectively. When combined to a PA, rituximab yields a 100 % response rate, even beyond frontline therapy. In contrast, response rate is only 82 % (59 % CHR) when rituximab is used alone. In this latter setting, relapse rate is 56 % and median time to relapse is 17.5 months. All eight patients who were treated two times with the antibody responded again to re-treatment. We confirm the high efficacy of the combination rituximab + PA. However, when rituximab is used as monotherapy, response rate is lower and the high relapse rate is a concern. Prospective clinical trials are needed to confirm the superiority of the combination rituximab + PA over PA alone, both as frontline therapy and at relapse.

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Conflict of interest

The authors declare that they have no conflict of interest.

Authors’ contribution

ML and AD designed the study; ML, FS, MPN, AV, XT, JFC, CT, FM, YB, JT, and AD provided the data; ML and CB performed the statistical analysis; ML and AD wrote the paper; all authors read and approved the final manuscript and agreed to submission.

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Authors and Affiliations

  1. Centre Hospitalier Universitaire (CHU) de Reims, Hôpital Robert Debré, Service d’Hématologie Clinique, Reims, France

    Mathieu Leclerc & Alain Delmer

  2. Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Service d’Hématologie Adultes, Paris, France

    Felipe Suarez

  3. Centre Hospitalier Régional Universitaire de Lille, Hôpital Claude Huriez, Service des Maladies du Sang, Lille, France

    Marie-Pierre Noël

  4. AP-HP, Hôpital Saint-Antoine, Service d’Hématologie, Paris, France

    Anne Vekhoff

  5. CHU de Caen, Hôpital Femme-Enfant-Hématologie, Service d’Hématologie Clinique, Caen, France

    Xavier Troussard

  6. CHU d’Amiens, Hôpital Sud, Service d’Hématologie Clinique et de Thérapie Cellulaire, Amiens, France

    Jean-François Claisse

  7. AP-HP, Hôpital Saint-Louis, Service d’Hématologie-Oncologie, Paris, France

    Catherine Thieblemont

  8. Groupe Hospitalier Saint-Vincent, Clinique Sainte-Anne, Service d’Oncologie et d’Hématologie, Strasbourg, France

    Frédéric Maloisel

  9. CHU of Liège and University of Liège, Liège, Belgium

    Yves Beguin

  10. AP-HP, Hôpital Cochin, Service d’Hématologie Clinique, Paris, France

    Jérôme Tamburini

  11. CHU de Reims, Hôpital Robert Debré, Service de Coordination à la Recherche Clinique, Reims, France

    Coralie Barbe

Authors
  1. Mathieu Leclerc
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  2. Felipe Suarez
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  3. Marie-Pierre Noël
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  4. Anne Vekhoff
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  5. Xavier Troussard
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  6. Jean-François Claisse
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  7. Catherine Thieblemont
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  8. Frédéric Maloisel
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  9. Yves Beguin
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  10. Jérôme Tamburini
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  11. Coralie Barbe
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  12. Alain Delmer
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Corresponding author

Correspondence to Mathieu Leclerc.

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Leclerc, M., Suarez, F., Noël, MP. et al. Rituximab therapy for hairy cell leukemia: a retrospective study of 41 cases. Ann Hematol 94, 89–95 (2015). https://doi.org/10.1007/s00277-014-2175-0

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  • DOI: https://doi.org/10.1007/s00277-014-2175-0

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