Answer:  It is somewhat unusual for a patient to have 3-4 recurrences, but it certainly does happen. When a patient has several recurrences we generally try to make sure the diagnosis is correct and try to determine if the patient might have the HCL variant which sometimes might explain the number of recurrences. While the best treatment for the first recurrence can be considered to be a second cycle of Cladribine, after 2 cycles even several years apart, we generally are enthusiastic about an alternative therapy if it is necessary. Cladribine can be repeated a number of times several years apart; however, as you suggest, it may cause further lowering of the blood counts and decrease in the immune system. There are several new treatment strategies which are available. One is BL22 and HA22 which are really 2 drugs chemically linked – an antibody and a toxin. These agents in general are available currently only at the NIH in Bethesda, Maryland. The other new treatment is a new oral pill called Vemurafenib which is effective in a seemingly unrelated disease called melanoma, a type of skin cancer. Patients with melanoma may have a specific genetic mutation called Braf against which this drug is effective. This same gene mutation was found in most patients also with HCL and this drug is now being tested in such patients. Currently, this drug appears very promising and is available only on a clinical trial available at the Memorial Sloan-Kettering Cancer Center in New York and Northwestern University Medical Center in Chicago, but will be available at several other centers soon.

Posted August 2013 in the category: Multiple Relapses