LETTER
2-Chlorodeoxyadenosine Treatment in Hairy Cell Leukemia
Ajay Anand, MD
15 January 1994 | Volume 120 Issue 2 | Page 169
TO THE EDITOR:
Drs. Saven and Piro [1] describe complete remissions induced by 2-chlorodeoxyadenosine (2-CdA) in patients with hairy cell leukemia who had not responded to 2'-deoxycoformycin (DCF) therapy. I draw attention to further data on the subject.
Another group of investigators treated two patients with hairy cell leukemia who were unresponsive to therapy with 2-DCF; one patient's marrow showed residual hairy cells, and the other had a residual bulky abdominal mass [2]. Both had a sustained, complete response to treatment with 2-CdA, thus supporting a lack of cross-resistance between these two purine analogs. The responses were achieved with a single cycle of 2-CdA, whereas DCF-induced remissions required multiple cycles.
As the authors state, both DCF and 2-CdA are adenosine deaminase inhibitors. The unique mode of 2-CdA-induced DNA damage in resting cells remains to be determined. A recent study examined the relation between pretreatment levels of deoxycytidine kinase and cytoplasmic 5'-nucleotidase in hairy cell leukemia and chronic lymphocytic leukemia in relation to the efficacy of 2-CdA therapy [3]. Not only were mean deoxycytidine kinase levels higher in 2-CdA responders than in nonresponders (P < 0.01), but mean 5'-nucleotidase levels were significantly lower in 2-CdA responders than in nonresponders (P < 0.05). This study provides insight into the cellular mechanisms of 2-CdA and predictors of response to this drug.
The ability of 2-CdA to induce complete responses in DCF-resistant patients with hairy cell leukemia represents an exciting new advance in the therapy of this condition. Larger studies are needed to determine whether patients who do not respond to DCF therapy will routinely respond to 2-CdA.
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Author and Article Information
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New England Deaconess Hospital; Boston, MA 02215
1. Saven A, Piro LD. Complete remissions in hairy cell leukemia with 2-chlorodeoxyadenosine after failure with 2'-deoxycoformycin. Ann Intern Med. 1993; 119:278-83.
2. Tallman MS, Hakimian D, Variakojis D, Koslow D, Sisney GA, Rademaker AW, et al. A single cycle of 2-chlorodeoxyadenosine results in complete remission in the majority of patients with hairy cell leukemia. Blood. 1992; 80:2203-9.
3. Kawasaki H, Carrera CJ, Piro LD, Saven A, Kipps TJ, Carson DA. Relationship of deoxycytidine kinase and cytoplasmic 5'-nucleotidase to the chemotherapeutic efficacy of 2-chlorodeoxyadenosine. Blood. 1993; 81:597-601.
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