LIJEČENJE LEUKEMIJE VLASASTIH STANICA KLADRIBINOM

Igor Aurer, Zdravko Mitrović, Jasminka Kovačević-Metelko, Ivo Radman,Sandra Bašić-Kinda, Koraljka Gjadrov-Kuveždić, Jasminka Jakić-Razumović, Klara Dubravčić, Sunčica Ries, Marin Nola, Silva Zupančić-Šalek, Boris Labar

Sažetak. Leukemija vlasastih stanica (triholeukemija) kronična je B-limfocitna leukemija karakterizirana kloskom proliferacijom vlasastih stanica. Terapija izbora su purinski analozi, u prvom redu kladribin. Liječili smo trideset bolesnika kontinuiranom infuzijom kladribina 7 dana u dozi od 0,1 mg/kg/dan ili dvosatnom infuzijom 5 uzastopnih dana u dnevnoj dozi od 0,14 mg/kg. Remisiju je postiglo 90% bolesnika. Nakon medijana praćenja od 44 mjeseca preživljavanje je 93%, a prosječno trajanje odgovora dulje od 6 godina. Dva bolesnika nisu reagirala na terapiju, a jedna bolesnica umrla je od infekcije kratko nakon terapije. Nuspojave su najčešće bile posljedica hematološke toksičnosti, neutropenični febrilitet zabilježen je kod 23% bolesnika, dok je 20% bolesnika trebalo transfuzije eritrocita i trombocita. Naši rezultati pokazuju da je kladribin siguran i učinkovit u liječenju leukemije vlasastih stanica. Nije bilo značajnijih razlika u toksičnosti i djelotvornosti između sedmodnevne kontinuirane i petodnevne intermitentne primjene lijeka.

Summary. Hairy cell leukemia is a chronic B-cell lymphoproliferative disorder characterized by clonal proliferation of hairy cells. Treatments of choice are purine analogues, particularly cladribine. We treated thirty patients with cladribine either by continuous 7-day infusion at a daily dose of 0.1 mg/kg or by 2-h infusion for 5 consecutive days at a daily dose of 0.14 mg/kg. Remission was achieved in 90% of the patients. After a median follow-up of 44 months overall survival is 93% and time to treatment failure more than 6 years. Two patients did not respond, one patient died of infection shortly after the treatment. Side-effects resulted mainly from hematological toxicity, 23% of the patients had neutropenic fever while 20% required platelets or packed red cell transfusions. Our results show that cladribine is safe and effective in the treatment of hairy cell leukemia. There were no significant differences in toxicity and response between 7-day continuous infusion and 5-day intermittent infusions of the drug.