|
1)
Decision To
Treat:
a)
About 10% of
Hairy Cell Leukemia patients remain asymptomatic with normal blood cell counts
and never require treatment.
b)
Treatment of
Hairy Cell Leukemia becomes warranted given the onset of:
i)
Significant
cytopenias: neutropenia, anemia or thrombocytopenia
ii)
Symptomatic
splenomegaly
iii)
Significant
constitutive symptoms: fever, fatigue, night sweats.
2)
Treatment
Status:
a)
Treatment
naïve: cladrabine and pentostatin are the treatments of choice.
b)
Treated
successfully and relapsed: If the patient responded initially and subsequently
relapsed, a second course of the same medication as that initially used will be
successful in about 70% of cases.
c)
Treatment
failure: treatment is indicated with a different purine analog from the one that
failed. Thus, if cladrabine was the first choice, treatment should be switched
to pentostatin – or vice versa.
3)
Leustatin is
considered indicated for the treatment of Hairy Cell Leukemia:
a)
For the
initial treatment of symptomatic Hairy Cell Leukemia (C91.40); OR
b)
For treatment
of relapse (C91.42) after successful initial treatment with Leustatin; OR
c)
For treatment
of patients who had no benefit from an initial course of pentostatin or
interferon (C91.40).
4)
Leustatin is
considered experimental and investigational for all other uses.
5)
Source:
This drug can be ordered through a contracted specialty pharmacy company. This
option will provide the medication to the physician’s office on the day
specified and in the dose required, at no expense to the physician. Billing for
the medication, in this circumstance, will be handled by the specialty pharmacy;
the physician will bill appropriate administration charges.
Codes Used In This BI:
J9065 Inj cladribine per 1 MG
|