Hairy cell leukemia: experimental therapy
new agents that spare residual immune effector cells (e.g. T cells) would be desirable. Consequently, novel agents that might be pursued include flavopir- idol and silvestrol, and other T cell-sparing agents that are effective in resistant CLL should be evaluated in this disease [26,27]. Flavopiridol, much like the early trials with the purine analogs, shows that this agent has durable effectiveness in patients with resistant CLL. Silvestrol, a natural product under preclinical development by the Na- tional Cancer Institute (NCI), appears to be highly selective for malignant B cells while sparing T cells. It will be important to continue to explore novel agents in hairy cell leukemia that show promising responses in patients with CLL. Agents such as silvestrol will require close observation once introduced into patients with CLL, as the potential for finding new agents for hairy cell leukemia will require exploring those entities that spare normal immune effector cells. The role for the combined use of chemo- immunotherapy (e.g. purine analog plus a mono- clonal antibody or an immunotoxin conjugate) will also need to be pursued in patients with high risk for relapse [28–30]. While enormous progress has been made in managing these patients, many unanswered questions remain. The establishment of the Hairy Cell Leukemia Consortium (
www.hairycell.org) is intended to address the exciting remaining questions and opportunities.
Potential conflict of interest: A disclosure form provided by the author is available with the full text of this article at
www.informahealthcare.com/lal.
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