Pentostatin: Impact on outcome in hairy cell leukemia

Major advances in the management of patients who have hairy cell leukemia have been made following the use of purine nucleoside analogs. Pentostatin and cladribine are equally effective, and have impressive long-term effectiveness. The gradual, but relentless, improvement in the peripheral blood counts enables the outpatient management with pentostatin in most patients. Cladribine affords the convenience of a single course of administration. A direct comparative study with these two agents is unlikely to yield dramatic differences in improvement. Patients still relapse, and the overall survival curves have not reached a plateau, which indicates that cure has not been secured. Future studies should be directed to optimizing the therapy for minimal residual disease as well as clearer definition of supportive care.