Landscape Change in the Treatment of Relapsed/Refractory HCL

Farhad Ravandi-Kashani, MD: In the relapse setting I would use the combination. We’ve been using cladribine and rituximab, and I’ve used pentoxide and rituximab once or twice, and that’s quite effective. In the few patients that we have had that we used a second-line therapy, the duration of remission has been longer than the first remission, which is against all the published literature...mentioned earlier—that with the single-agent nucleoside analog therapy, second and third uses of nucleoside analog are usually associated with lower response rate and shorter response duration.

But when we introduced the rituximab to cladribine in the relapse setting, the second remission has been longer than the first remission in the few patients that we have had enough time to follow up. This has also been shown by Dr Claire E. Dearden at The Royal Marsden in the UK. I don’t think she has published that, but they also show that the combination produces second remissions that are longer than the first remission.

One other area that I wanted to touch that we didn’t cover is in variant hairy cell. I do believe that in variant hairy cell, the combination cladribine plus rituximab—or as Dr Robert J. Kreitman has published, bendamustine plus rituximab—is the way to go because we all know that single-agent nucleoside analog therapy in variant hairy cell is associated with lower response rate and also definitely shorter response duration. The addition of rituximab does not cure these patients, but it does produce higher response rate and longer response duration.

Transcript Edited for Clarity