毛状细胞白血病(HCL)是一种罕见的淋巴增生性疾病,经克拉屈滨(2CDA)治疗后预后良好,尽管在随访期间可能会复发。这项研究的目的是回顾疗效,安全,长期缓解率,接受2CDA作为一线治疗的患者的总生存期(OS)。我们回顾性审查了1991年3月至2019年5月在18个意大利血液学中心接受2CDA治疗的HCL患者的数据:513例患者可用于研究目的。在84.9%的病例中,中位年龄为54岁(范围24-88),ECOG为0。共有330例(64.3%)患者静脉内接受2CDA,皮下接受183例(35.7%)。ORR为91.8%:335例患者获得CR(65.3%),PR为96(18.7%),40例(7.8%)患者有血液学反应;42例(8.2%)患者无反应。血红蛋白值(p=0.044),循环毛细胞的频率(p=0.039),中性粒细胞绝对计数的恢复(p=0.006),在单变量分析中,与PR相比,脾脏正常化(p≤0.001)与CR相关。中位随访时间为6.83年(范围0.04-28.52),中位复发时间为12.2年.在获得CR和PR的患者之间确定了反应持续时间的显着差异(19.4年对4.8年,p<0.0001)。在103(20.1%)患者中报告了非血液学3级或更高的早期毒性。未达到中位OS:95.3%,92.4%,81.8%的患者估计在5年、10年和15年还活着,分别。49名病人死亡(9.5%),14例(2.7%)感染后,14人中的自然原因(2.7%),13例心血管事件(2.5%),6例第二次肿瘤(1.2%),HCL进展2例(0.4%)。用2CDA处理HCL后,80%的患者估计在诊断后15年还活着。
Hairy cell leukemia (HCL) is a rare lymphoproliferative disease with an excellent prognosis after treatment with cladribine (2CDA), although relapse may occur during follow-up. The aim of the
study is to review the efficacy, safety, long-term remission rate, and overall survival (OS) in those patients who received 2CDA as first-line treatment. We retrospectively reviewed data of HCL patients treated with 2CDA between March 1991 and May 2019 at 18 Italian Hematological centers: 513 patients were evaluable for
study purpose. The median age was 54 years (range 24-88) and ECOG was 0 in 84.9% of cases. A total of 330 (64.3%) patients received 2CDA intravenously and 183 (35.7%) subcutaneously. ORR was 91.8%: CR was obtained in 335 patients (65.3%), PR in 96 (18.7%), and hematological response in 40 (7.8%) patients; in 42 (8.2%) no response was observed. Hemoglobin value (p = 0.044), frequency of circulating hairy cells (p = 0.039), recovery of absolute neutrophil count (p = 0.006), and normalization of spleen (p ≤ 0.001) were associated with CR compared to PR in univariable analysis. At a median follow-up of 6.83 years (range 0.04-28.52), the median time to relapse was 12.2 years. A significant difference in duration of response was identified between patients that obtained a CR and PR (19.4 years versus 4.8 years, p < 0.0001). Non-hematological grade 3 or higher early toxicity was reported in 103 (20.1%) patients. Median OS was not reached: 95.3%, 92.4%, and 81.8% of patients were estimated to be alive at 5, 10, and 15 years, respectively. Forty-nine patients died (9.5%), following an infection in 14 cases (2.7%), natural causes in 14 (2.7%), cardiovascular events in 13 (2.5%), a second neoplasm in 6 (1.2%), and progression of HCL in 2 cases (0.4%). Following treatment of HCL with 2CDA, 80% of patients are estimated to be alive 15 years after diagnosis.