Effective therapeutic options for patients with relapsed or refractory HCL include repeated courses of purine analogs, palliative splenectomy, or interferon, ritux-imab, and the recombinant immunotoxins BL22 and LMB-2. Data are insufficient to determine whether BL22 is better than LMB-2 for CD25 + HCL, but as 20% of HCL patients have CD25~ HCL cells, BL22 is the agent that has been developed more for this disease. Additional phase II clinical testing is under way to establish the safety and optimal dosing of BL22 for efficacy, and similar testing is also being done with rituximab.

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