Sezione di Ematologia e Trapianti, Dipartimento di Medicina Clinica e Scienze Immunologiche, Università di Siena & AOUS, Siena, Italy.
Leuk Lymphoma. 2011 Jun;52 Suppl 2:34-7. doi: 10.3109/10428194.2011.570395. Epub 2011 Apr 19.
Nucleoside derivative cladribine treatment in hairy cell leukemia (HCL) is a rare example of treatment success in cancer. In fact, HCL is generally responsive to single-agent cladribine and only a minority of patients are refractory. Cladribine was originally administered intravenously as a continuous infusion at a dose of 0.1 mg/kg/day for 7 consecutive days. Subsequently cladribine has been administered intravenously, as a 2 h infusion for 5 consecutive days or weekly for 7 weeks, or subcutaneously. These regimens are all very effective but often show relevant toxicity. The subcutaneous route is easier to administer and may increase compliance of the patient. We have had the opportunity to investigate the efficacy and toxicity of subcutaneous cladribine given at the dose of 0.1 mg/kg/day for 5 or 7 days as a single course in newly diagnosed HCL requiring treatment, in an ongoing Italian multicenter clinical trial. Overall responses have been no different in the two arms, while a much lower infection rate was observed when cladribine was given at the lowest dose. Subcutaneous administration may be deemed a very convenient route since it does not require hospitalization. A reduced dosage of cladribine may also be advantageous since it may be associated with reduced toxicity and may set the dose needed for combinations with antibody treatments.
核苷类似物克拉屈滨治疗毛细胞白血病（HCL）是癌症治疗成功的罕见范例。事实上，HCL 通常对单药克拉屈滨有反应，只有少数患者有耐药性。克拉屈滨最初以 0.1mg/kg/天的剂量静脉内连续输注 7 天。随后，克拉屈滨已静脉内输注，连续 5 天输注 2 小时或每周输注 7 周，或皮下给药。这些方案都非常有效，但通常会显示出相关的毒性。皮下给药途径更容易给药，并可能提高患者的依从性。我们有机会在一项正在进行的意大利多中心临床试验中，研究新诊断的需要治疗的 HCL 患者，给予 0.1mg/kg/天，连续 5 天或 7 天的单疗程皮下克拉屈滨的疗效和毒性。在两个治疗组中，总体反应没有差异，而克拉屈滨给予最低剂量时观察到的感染率要低得多。由于不需要住院，皮下给药可能被认为是一种非常方便的途径。克拉屈滨的剂量减少也可能是有利的，因为它可能与降低毒性有关，并可能确定与抗体治疗联合使用的剂量。
