Rituxan Combinations Show Longer Remissions in Hairy Cell Leukemia

Combining Rituxan (rituximab) with Mavenclad (cladribine) or Zelboraf (vemurafenib) in the first-line setting can produce longer, more durable remissions for hairy cell leukemia, Dr. Farhad Ravandi, told CURE during the Hairy Cell Leukemia Foundation 2025 Conference in Bologna, Italy.

Ravandi said while single agent Mavenclad can produce high response rates, waiting until relapse doesn’t allow patients to achieve the longest possible opportunity for remission. Advances in expertise and supportive care have minimized the toxicity and risks of these therapies, making upfront combination treatment a safe and effective option. He said there is ample data showing the combination is superior to single-agent therapy and should become the standard in all guidelines.

Ravandi is the Dallas/Fort Worth Living Legend Chair for Cancer Research III, professor of medicine and chief of section of acute myeloid leukemia in the Department of Leukemia at The University of Texas MD Anderson Cancer Center.

Transcript

As this meeting brings together leading experts in hairy cell leukemia, what is one key advancement, clarification, or consensus in diagnosis or treatment that you hope will emerge from the discussions by the end of the conference?

I'm a strong believer in the use of Rituxan in the frontline setting, in addition to Mavenclad or Zelboraf, whichever choice is appropriate for the patient. I do see the argument that you get very high responses with cladribine alone or with pentostatin alone, and why not wait for the relapse setting? But I am a strong believer that the best time to treat any leukemia is the first time, because nowadays we have agents that can actually produce very long and durable remissions, and I don't think any patient is really interested in seeing the disease again.

The toxicity and risks associated with these agents have been minimized because of the large amount of expertise that now exists worldwide. Therefore, I do not see why Rituxan shouldn't be added to Mavenclad in the first-line setting, because there's plenty of data to suggest the combination is definitely better than single-agent therapy. I think that should become the standard first-line therapy in all guidelines. There may be people who feel that I have a personal bias because we described it the first time, but that's not the reason why I'm saying this now.

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