Sixty-six patients received a first-line treatment, and 2-chlorodeoxyadenosine (cladribine-2-CdA) was administered in thirty-one, nineteen patients received interferon-alpha (INF-α), splenectomy was performed in 16 cases, and rituximab was used in one.
Although the highest overall response rate (ORR) was observed in patients receiving upfront 2-CdA, ORRs were comparable in 2-CdA, INF-α, and splenectomy subgroups. And relapse rates were significantly lower in patients who received first-line 2-CdA. Progression-free survival (PFS) rate with 2-CdA was significantly higher than those with INF-α and splenectomy, but we found similar overall survival (OS) rates with all three upfront treatment modalities. Infections including tuberculosis were a major problem.
Although purine analogues improved the ORRs and PFS there is still much to go with regard to OS and relapsed/refractory disease in patients with HCL.