Biweekly cladribine and rituximab in a patient with hairy cell leukemia and severe renal failure

Hairy cell leukemia (HCL) is a rare indolent lymphoproliferative disorder usually clinically characterized by pancytopenia and splenomegaly. It is very sensitive to purine analogues cladribine and pentostatin which are both primarily excreted by kidneys and registration labels bear warnings against their use in patients with severe renal insufficiency. We report a patient with HCL and severe renal failure who was successfully treated with five subcutaneous injections of cladribine 0.14 mg/ kg and six biweekly infusions of rituximab 375 mg/2 iv. This regimen was tolerated remarkably well without cumbersome side–effects. Our case-report suggests that cladribine can be efficaciously and safely used in patients with severe renal insufficiency if administered in standard doses once every two weeks.