ALTERNATING 2'-DCF AND RECOMBINANT LEUKOCYTE A IFN IN HAIRY CELL LEUKEMIA

我们给予脱氧考福霉素(DCF)和干扰素-α(干扰素-α)。 对毛细胞白血病患者进行序贯治疗，试图改善 在使用每种药物的早期研究中观察到的应答率和持续时间 独自一人。这项研究的进一步理论基础包括观察到干扰素- 对甲型肝炎耐药的患者对二线的反应几乎一致 DCF.由于有一些重叠的毒性，我们决定对 药物是顺序的，而不是同时的。在这项研究中，我们评估了 患者行双侧髂骨骨髓移植的疗效 活组织检查和抽吸，因为外周血在术后迅速恢复正常 无论是干扰素-α还是DCF治疗，但疾病在骨骼中变得斑驳 如果只有单侧骨髓活检有 已经完成了。单独使用干扰素-α或DCF的其他研究 单侧骨髓检查评价疗效。使用这些更多 放宽了回答标准，作者发表了高完成率 减刑至DCF。在进入我们研究的15名患者中，14名是可评估的 对于一名弥漫性骨硬化患者的反应不是 可评估骨髓反应。所有患者均迅速恢复正常。 外周血细胞计数和所有14名可评估骨髓的患者均被发现 数量非常少(不到骨髓细胞总数的5%) 治疗完成后残留毛细胞。在14个国家中 可评估的患者，三名患者已发展为进展性疾病 治疗。单个无法评估的弥漫性骨硬化症患者 出现贫血并伴有血清可溶性IL-2受体(sIL-2R)升高 与进行性毛细胞白血病的水平一致。两名病人 接受了2-氯脱氧腺苷治疗，1人接受了 干扰素-α。尽管对组合的初始应答率 DCF和干扰素的疗效似乎并不比DCF好 单独而言，响应持续时间可能会更长。剩下的病人 继续跟踪以确定应答持续时间。

We administered deoxycoformycin (dCF) and interferon-alpha (IFN-alpha) sequentially to patients with hairy cell leukemia in an attempt to improve the response rate and duration observed in earlier studies using each drug alone. Further rationale for this study included the observation that IFN- alpha resistant patients were nearly uniformally responsive to second line dCF. As there was some overlapping toxicity, we decided to administer the drugs sequentially rather than concurrently. In this study, we evaluated patients for response by performing bilateral iliac crest bone marrow biopsies and aspirates since the peripheral blood normalizes rapidly after either IFN-alpha or dCF treatment but disease becomes patchy in the bone marrow and might be missed if only unilateral bone marrow biopsies had been performed. Other studies using IFN-alpha or dCF alone used unilateral marrow examinations in evaluating response. Using these more relaxed criteria of response, authors had published high rates of complete remission to dCF. Of 15 patients entered in our study, 14 are evaluable for response with one patient having diffuse osteosclerosis not being evaluable for marrow response. All patients had rapid normalization of peripheral blood count and all 14 marrow-evaluable patients were found to have very small numbers (less than 5% of the total marrow cellularity) of residual hairy cells at the completion of treatment. Among the 14 evaluable patients, three patients have developed progressive disease off treatment. The single nonevaluable patient with diffuse osteosclerosis developed anemia with increasing serum soluble IL-2 receptor (sIL-2R) levels consistent with progressive hairy cell leukemia. Two patients received treatment with 2-chlorodeoxyadenosine and one received interferon-alpha. Although the initial response rate to the combination of dCF and interferon appears to be no better than that observed with dCF alone, the response duration may be longer. The remaining patients continue to be followed for determination of response duration.