Martin A, Nerenstone S, Urba W J, Longo D L, Lawrence J B, Clark J W, Hawkins M J, Creekmore S P, Smith J W, Steis R G
Biological Response Modifiers Program and Program Resources, Inc, National Cancer Institute-Frederick Cancer Research Facility, MD 21701.
J Clin Oncol. 1990 Apr;8(4):721-30. doi: 10.1200/JCO.1990.8.4.721.
Fifteen patients with hairy cell leukemia (HCL) were treated with deoxycoformycin (pentostatin; dCF) (4 mg/m2 intravenous [IV] every week x 3) and recombinant interferon-alpha 2a (rIFN-alpha 2a) (3 x 10(6) units subcutaneously [SC] daily x 4 weeks) in alternating months for a total of 14 months. Eleven patients had undergone splenectomy; four had received prior systemic therapy with chlorambucil and/or steroids. All 15 are evaluable for toxicity and peripheral blood response, while 14 are assessable for bone marrow response. Toxicity was tolerable with grade 3 or 4 nausea and vomiting in three patients, neutropenic fevers in five, transient but significant depression in eight, and localized cutaneous herpes zoster in four. Circulating hairy cells were undetectable by the end of the first month in 10 of 13 patients, and by the end of the second month in the other three. Fourteen patients had bilateral bone marrow biopsies performed at baseline after 6 months of treatment, at the end of treatment (14 months), and at 6-month intervals during follow-up. Before treatment, all patients had hypercellular marrows with hairy cels replacing normal marrow elements; all showed at least a 95% clearing of their hairy cell infiltrate by 6 months of therapy. However, small collections of residual hairy cells could be detected intermittently on at least one side of bilateral samples in all patients. All patients have completed treatment with a median duration of follow-up off therapy of 27 months (range, 15 to 31 months). To date, all peripheral counts and serum soluble interleukin-2 receptor (sIL2R) levels remain stable, and no patient has had progression of the hairy cell infiltrate in the bone marrow. Although no patient achieved a pathologic complete response, alternating monthly cycles of dCF and rIFN-alpha 2a produced durable partial remissions (PRs) in all patients. Continued follow-up is required to determine the length of such remissions.
15例毛细胞白血病（HCL）患者接受了脱氧助间型霉素（喷司他丁；dCF）（4mg/m²静脉注射[IV]，每周1次，共3次）和重组干扰素-α2a（rIFN-α2a）（3×10⁶单位皮下注射[SC]，每日1次，共4周）交替治疗，为期14个月。11例患者接受过脾切除术；4例曾接受过苯丁酸氮芥和/或类固醇的全身治疗。所有15例患者均可评估毒性和外周血反应，14例可评估骨髓反应。毒性可耐受，3例患者出现3或4级恶心和呕吐，5例出现中性粒细胞减少性发热，8例出现短暂但明显的抑郁，4例出现局部皮肤带状疱疹。13例患者中有10例在第1个月末循环中的毛细胞检测不到，另外3例在第2个月末检测不到。14例患者在基线、治疗6个月后、治疗结束时（14个月）以及随访期间每6个月进行一次双侧骨髓活检。治疗前，所有患者骨髓细胞增多，毛细胞取代正常骨髓成分；治疗6个月时，所有患者毛细胞浸润至少清除95%。然而，在所有患者双侧样本的至少一侧可间歇性检测到少量残留毛细胞。所有患者均已完成治疗，治疗后随访的中位时间为27个月（范围15至31个月）。迄今为止，所有外周血细胞计数和血清可溶性白细胞介素-2受体（sIL2R）水平保持稳定，且无患者骨髓中毛细胞浸润进展。虽然没有患者达到病理完全缓解，但dCF和rIFN-α2a每月交替治疗周期在所有患者中产生了持久的部分缓解（PR）。需要继续随访以确定此类缓解的持续时间。
