Recommendations for first-line therapy
| In the absence of renal impairment or active infection, therapy should consist of a standard regimen of a purine nucleoside analog (either cladribine or pentostatin). |
| Cladribine administered as continuous intravenous infusion 0.1 mg/kg per day for 7 days, or 0.14 mg/kg/day intravenously over 2 hours once per day for 5 days, or 0.1-0.14 mg/kg/day subcutaneously once per day for 5 days.22,23,55,56,79 |
| Pentostatin 4 mg/m2 intravenously once every 2 weeks.50,55 |
| If active infection is present, attempts to control infection should be pursued before instituting the purine nucleoside regimen. |
| If it is not possible to control infection, alternative therapy with interferon alpha, low-dose pentostatin, or newer agents (eg, vemurafenib) not associated with worsening myelosuppression may be used to improve the absolute neutrophil count in an attempt to control infection before using regular-dose purine analogs to secure a durable response. |
| Response should be formally assessed at the conclusion of primary therapy. |
| In the absence of renal impairment or active infection, therapy should consist of a standard regimen of a purine nucleoside analog (either cladribine or pentostatin). |
| Cladribine administered as continuous intravenous infusion 0.1 mg/kg per day for 7 days, or 0.14 mg/kg/day intravenously over 2 hours once per day for 5 days, or 0.1-0.14 mg/kg/day subcutaneously once per day for 5 days.22,23,55,56,79 |
| Pentostatin 4 mg/m2 intravenously once every 2 weeks.50,55 |
| If active infection is present, attempts to control infection should be pursued before instituting the purine nucleoside regimen. |
| If it is not possible to control infection, alternative therapy with interferon alpha, low-dose pentostatin, or newer agents (eg, vemurafenib) not associated with worsening myelosuppression may be used to improve the absolute neutrophil count in an attempt to control infection before using regular-dose purine analogs to secure a durable response. |
| Response should be formally assessed at the conclusion of primary therapy. |