LETTER
Cross-Resistance to Purine Analogs in Hairy Cell Leukemia
Eric H. Kraut, MD
1 February 1994 | Volume 120 Issue 3 | Pages 247-248
TO THE EDITOR:
I read with interest the article by Drs. Saven and Piro on the response of patients with hairy cell leukemia to 2-chlorodeoxyadenosine (2-CdA) after treatment with deoxycoformycin (dCF) failed [1]. In our experience, approximately 85% of patients respond completely to dCF [2]. Our results with 2-CdA after no response to dCF or another purine antimetabolite, fludarabine phosphate, are not as encouraging. We have treated three patients with 2-CdA for refractory hairy cell leukemia. Two had relapsed from dCF-induced complete remission and did not respond to retreatment. One patient was also given fludarabine phosphate before 2-CdA treatment. Neither showed a significant response to 2-CdA. A third patient who did not respond to interferon or dCF responded to fludarabine phosphate [3]. When his condition progressed, further treatment with fludarabine phosphate and 2-CdA was ineffective.
Saven and Piro's conclusion that no cross-resistance exists between dCF and 2-CdA may be premature. As our experience with nucleoside treatment of patients with hairy cell leukemia expands, we expect to see more patients who, on relapse, do not respond to therapy. Although some patients may obtain significant responses from either drug after treatment failure, our results suggest that additional therapies for hairy cell leukemia should be sought for those few patients who are resistant to all treatment.
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Author and Article Information
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The Ohio State University; Columbus, OH 43210-1228
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. Kraut EH, Bouroncle BA, Grever M. Pentostatin treatment of advanced hairy cell leukemia. J Clin Oncol. 1989; 7:168-72.
3. Kraut EH, Chun H. Fludarabine phosphate in refractory hairy cell leukemia. Am J Hematol. 1991; 37:59-60.
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