T cells and natural killer cells after treatment of hairy cell leukaemia with 2-chlorodeoxyadenosine

We report that continuous suppression of CD4+ lymphocyte subsets does not necessarily lead to an increased rate of infections more than 6 months after treatment of hairy cell leukemia (HCL) with 2-chlorodeoxyadenosine (cladribine; 2-CdA). In a retrospective analysis of 17 consecutive patients with HCL treated with 2-CdA and followed thereafter for an average of 440 days (ranging from 71 to 1,046 days), all lymphocyte subsets significantly decreased after therapy. However, natural killer (NK) cells increased to 203 cells/microliter during the following 4 months, whereas CD3+ and CD4+ T cell subsets did not reach pretreatment values even more than 1 year after 2-CdA therapy. In our study group, 5 opportunistic infections occurred during the first 2 weeks after treatment with 2-CdA, and no severe infections were registered after this early leukopenic phase. A review of the current literature revealed that at least 56 infections occurred in 158 patients repeatedly treated with 2CdA for low-grade lymphoproliferative diseases other than HCL (= 35%). In patients with HCL, the rapid increase of NK cell counts after 6 months might be responsible for reducing the risk of severe infections after the early leukopenic phase despite CD4+ cell suppression.