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2-Chlorodeoxyadenosine Treatment in Hairy Cell Leukemia
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
