RESUMEN
PURPOSE: To evaluate the clinical efficacy and safety of 2-chlorodeoxyadenosine (CdA) when administered by subcutaneous injection to patients with symptomatic hairy cell leukemia (HCL), and to evaluate predictive factors for response. PATIENTS AND METHODS: Seventy-three patients were given CdA as a subcutaneous injection once daily for 7 days. Complete remission (CR) required normalized blood counts and the absence of B-ly 7-positive bone marrow cells by flow cytometry. CdA concentrations in plasma following the first injection were analyzed by high-pressure liquid chromatography. RESULTS: Fifty-nine patients (81%) achieved a durable CR after one (n = 55) or two courses, and 10 had a partial remission (PR). With a median follow-up duration of 20 months, no patient had a clinical relapse. Neutropenic fever that required intravenous antibiotics occurred in 28 patients (38%). No toxicity at injection sites was observed. Incomplete response was predicted by an elevated lymphocyte count and serum beta 2-microglobulin level, and by a high percentage of hairy cells in the bone marrow. Plasma CdA levels were similar to those achieved from intravenous administration. CONCLUSION: Subcutaneous injection of CdA is safe and as effective as continuous infusion without problems associated with the mode of administration. Our schedule simplifies CdA treatment and can be generally recommended.
Asunto(s)
Cladribina/administración & dosificación , Leucemia de Células Pilosas/tratamiento farmacológico , Adulto , Anciano , Médula Ósea/patología , Cladribina/efectos adversos , Cladribina/farmacocinética , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Subcutáneas , Leucemia de Células Pilosas/sangre , Leucemia de Células Pilosas/patología , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , Noruega , Inducción de Remisión , Microglobulina beta-2/metabolismoRESUMEN
Patient autonomy should be respected when information is given about serious and life-threatening disease. The patient must be allowed to choose how much he or she wants to know concerning prognosis, and informed consent should be sought early on with regard to which level of autonomy the patient desires. A number of possible explanations as to why doctors conceal information from patients are discussed. Concealing information may damage the patient's trust in the physician. By not providing full information about a deadly disease, a physician may in turn be forced to bear the affliction of another's fears.