Talk:Hairy cell leukemia

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I dont agree that fludarabine is ineffective againts hairy cell leukaemia. Fludarabine is porbably as effective as 2CDA, but has less studies.

see for instance http://content.nejm.org/cgi/content/extract/330/10/691


Well... actually, no. Fludarabine is actually better studied and used more, in general, than either cladribine or pentostatin -- it's just not used, nor particularly effective, for HCL. Here's why I think the statement is justified as it stands:
  • Fludarabine is not approved for use against HCL by any government regulatory agency (e.g., the FDA in the U.S. or any of the European agencies)
  • The folks at Kreitman's lab at the NIH (home of the BL22, HA22, and LMB-2 clinical trials) say that it basically has no value for HCLers.
  • Nobody, including Saven [who wrote the article you cite] actually uses it to treat HCL. (Not being able to read the whole article online, I can't tell you what he says about it, just that he mentions its existence in that article.)
  • Fludarabine (in the U.S.) has got a big black-box warning because it's very messily fatal when combined with pentostatin.
  • It appears that two HCLers are dead from an extremely rare autoimmune disease after fludarabine treatment: http://www.blackwell-synergy.com/links/doi/10.1046/j.1365-2141.2000.02058.x/abs/
http://www.meb.uni-bonn.de/cgi-bin/mycite?ExtRef=MEDL/91121422 is the first report of fludarabine in treating HCL. They got two partial responses and one minor response -- which is pretty much a failure, compared to the numbers that you get from cladribine and pentostatin (80% complete responses, 15% partial responses), even when you consider that the patients in this fludarabine study weren't treatment-naive.
But if that's your definition of "effective," then perhaps we just have different standards for what constitutes effective. It seems to me that cladribine and pento are better for HCL. (I freely admit that fludarabine is better for regular B-CLL.)
To be fair, fludarabine may be slightly more neglected in HCL than it needs to be; there is a possibility that it could be at least partly helpful to some patients. However, by the time you're resistant to cladribine and pentostatin, then you're caught in the cross-resistance problem involving this class of drugs. And no one starts with fludarabine -- why would anyone want to start with the drug that's least likely to work for them? WhatamIdoing 06:24, 5 March 2007 (UTC)