Hematology/oncology clinics of North America

Pentostatin: impact on outcome in hairy cell leukemia.

PMID 16990110


Major advances in the management of patients who have hairy cell leukemia have been made following the use of purine nucleoside analogs. Pentostatin and cladribine are equally effective, and have impressive long-term effectiveness. Although the degree of myelosuppression may be less with the use of pentostatin, this may reflect differences in the schedule and dose of drug administration between these agents. The gradual, but relentless, improvement in the peripheral blood counts enables out-patient management with pentostatin in most patients. Cladribine affords the convenience of a single course of administration. A direct comparative study with these two agents is unlikely to yield the optimal management of patients who have minimal residual disease following the administration of either agent is warranted in the context of a clinical trial. Patients do relapse, and the overall survival curves have not reached a plateau, which indicates that cure has not been secured. The satisfaction of having improved the outcome for patients who have this previously untreatable leukemia should not give way to complacency for further improvement in the management of this disease. Future studies should be directed to optimizing the therapy for minimal residual disease as well as clearer definition of supportive care.