Hairy cell leukemia. An update on a cohort of 93 patients treated in a single institution. Effects of interferon in patients relapsing after splenectomy and in patients with or without maintenance treatment.
Hairy cell leukemia. An update on a cohort of 93 patients treated in a single institution. Effects of interferon in patients relapsing after splenectomy and in patients with or without maintenance treatment.
复制标题
毛细胞白血病。
作者：
X. Troussard;G. Flandrin
我们回顾性分析了93例毛细胞白血病患者的干扰素α-2（IFN）治疗结果，其中31例曾行脾切除术。84例（90%）完成诱导治疗（3 x 10（6）U，每周3次，持续12个月）。在76例患者中观察到外周血液学反应。两名患者有持续性脾肿大，并在脾切除术后观察到反应。另外5例患者在诱导治疗18-24个月后有反应，1例无反应。在28例接受维持治疗（每周1 × 10（6）U 3 ×）的患者中，中位随访30个月后无患者复发。毒性水平可接受，未观察到IFN抗性。另一方面，在56名未接受维持治疗的患者中，37名患者在中位19个月时复发。32例可评价患者中有30例对第二疗程IFN仍有反应。在19例未复发的患者中，11例接受了脾切除术，而37例患者中0例复发（p < 0.001）。总之，该研究显示了以下内容：（1）IFN提供了极好的缓解而没有主要的毒副作用;（2）长期维持耐受性良好并防止了外周血液学复发;（3）缺乏维持治疗与需要第二次治疗的外周血液学复发相关;和（4）某些先前脾切除的患者可能不需要维持治疗。这些长期结果必须与新药的有效性和毒性进行比较，如喷司他丁和2-氯脱氧腺苷。
We retrospectively analysed the results of interferon alpha-2 (IFN) treatment in 93 patients with hairy-cell leukaemia, of which 31 had previously undergone splenectomy. Induction treatment (3 x 10(6) U three times weekly for 12 months) was completed in 84 cases (90%). Peripheral hematological response was observed in 76 patients. Two patients had persistent splenomegaly, and response was observed in both cases after splenectomy. Five additional patients were responsive after 18-24 months of induction treatment and 1 was unresponsive. Of 28 patients on maintenance treatment (1 x 10(6) U 3 x per week), no patient relapsed after a median follow-up of 30 months. The toxicity level was acceptable and IFN resistance was not observed. On the other hand, of 56 patients without maintenance treatment, 37 relapsed at a median of 19 months. Thirty of 32 evaluable patients remained responsive to a second course of IFN. Of 19 patients without relapse, 11 had undergone splenectomy compared to 0/37 patients who relapsed (p < 0.001). In conclusion, the study shows the following, (1) IFN, provides excellent palliation without major toxic side effects; (2) long term maintenance was well tolerated and prevented peripheral haematological relapse; (3) lack of maintenance treatment was associated with peripheral haematological relapse requiring a second treatment; and (4) certain previously splenectomized patients may not require maintenance treatment. These long term results must be compared with the effectiveness and toxicity of new drugs, such as pentostatin and 2-chloro-deoxy-adenosine.