Refractory and Relapsed
Some patients still have leukemia cells in their bone marrow after hairy cell leukemia treatment. The term refractory leukemia is used to describe leukemia that doesn't result in a remission (no sign of the disease).
If leukemia in your bone marrow returns and your normal blood cells decrease after a remission, you're having what's called a relapse.
You and your doctor have several treatment alternatives:
- If you don't respond to initial chemotherapy with cladribine (Leustatin®) or if you relapse after achieving remission, your doctor will likely give you another chemotherapy drug, pentostatin (Nipent®). Pentostatin has proven highly successful in achieving favorable response rates. It's given by vein (intravenously) for about 20 minutes every other week over three to six months.
- If you relapse after being treated with cladribine or pentostatin, your doctor may repeat your initial chemotherapy drug regimen or treat you with the drug interferon-alfa (Roferon®-A or Intron® A). Interferon, which can kill hairy cells, is normally given three times a week by injection for as long as one year. You may need to continue interferon for a long-term period as a maintenance therapy to manage the disease. Interferon can produce side effects like fatigue, fever and bone pain.
- If you don't respond to any of the aforementioned chemotherapy drugs, your doctor may give you the monoclonal antibody rituximab (Rituxan®), which targets a characteristic marking (antigen) found on the surface of B lymphocytes that develop into hairy cells. Or your doctor may give you a different agent called BL22, an immunoconjugate that combines an antibody with another toxic drug. Like rituximab, BL22 also targets a specific antigen on hairy cells. Researchers are studying both approaches in clinical trials for hairy cell leukemia.
- If you have a significantly enlarged spleen and haven't responded to, or relapsed after, treatment with cladribine, pentostatin, rituximab and BL22, you might have your spleen removed (splenectomy).
- If you don't respond to chemotherapy or other therapies, you might be considered for an allogeneic stem cell transplantation although it comes at high risk. Allogeneic stem cell transplantation involves transferring stem cells from a healthy person (the donor) to the patient. The procedure follows high-intensity chemotherapy and sometimes radiation. It's normally used for only a small number of younger patients who have a matched donor.
If you would like to read about these drugs individually, including information about side effects, click here.
You and your doctor may decide that the best treatment route for you is one being studied in a clinical trial.