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. 2015 Oct 16;7(1):e2015058.
doi: 10.4084/MJHID.2015.058. eCollection 2015.

Efficacy and Safety of Cladribine: Subcutaneous versus Intravenous Administration in Hairy Cell Leukemia Patients

Ola Khorshid  1 , Alfred Elias Namour  1 , Mosaad M El-Gammal  1 , Tarek Yakout Mahmoud  1 , Catherine Fortpied  1 , Raafat Abdel-Malek  2 , Safaa Ramadan  1
Affiliations

Efficacy and Safety of Cladribine: Subcutaneous versus Intravenous Administration in Hairy Cell Leukemia Patients

Ola Khorshid et al. Mediterr J Hematol Infect Dis. .

Abstract

Cladribine induces durable complete remission (CR) in approximately 85% of hairy cell leukemia (HCL) patients. In Egypt, cladribine is mainly used as IV continuous infusion at a dose of 0.1 mg/kg/day for 7 days and as SC bolus injection at a dose of 0.14 mg/kg/day for 5 days. We aimed to compare the outcome and toxicity between these two regimens. We retrospectively collected data from HCL patients treated at the National Cancer Institute and its affiliated center, Nasser Institute, Cairo, Egypt. Forty-nine patients were identified, 18 treated with the IV regimen (IV group) and 31 with the SC regimen (SC group). Forty-one patients were newly diagnosed. Patient characteristics were balanced across the two groups. The CR rates in the IV and the SC group were 94% and 97%, respectively. The main complications in the IV group and the SC were neutropenia G3-4 (67% vs. 87%), mucositis mainly G1-2 (67% vs 32%) and infections (mainly viral, 78% vs 34%). In the IV group, five patients died, three of progression and infection, one of unknown cause and one of late heart failure. In the SC group, one patient died of disease progression and one of second cancer. After 33.5 months, median follow-up, the 3-year event free survival was 60% and 96%, respectively (p=0.104). The 3-year overall survival was 81% and 100%, respectively (p=0.277). In conclusion, SC cladribine is an excellent alternative to the IV regimen for the treatment of HCL.

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Figures

Figure 1
Figure 1
EFS of the IV and SC cladribine group.
Figure 2
Figure 2
Event Free Survival, by response at month 4 (CR versus PR) – Landmark analysis. Months counted from the landmark time of 4 months.
Figure 3
Figure 3
OS of the IV and the SC group.
See this image and copyright information in PMC

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