Hairy cell leukemia (HCL) tends to grow slowly. Patients without symptoms often don't need to be treated right away, but they do need to be watched carefully. Doctor visits are done every few months to check for signs that the HCL is growing and to see if it's causing any problems (like low blood counts, fatigue, or an enlarged spleen). Some people with HCL live for many years without having symptoms or getting treatment.
Treatment may be advised for HCL patients with low blood cell counts, recurrent infections, or an enlarged spleen or lymph nodes. Treatment is most often with chemo using one of the purine analog drugs -- either cladribine (2-CdA) or pentostatin. Most patients get a good response with these drugs, and the responses often last more than 5 years.
If the leukemia comes back, it can often be treated with a purine analog again. Often the same drug will be used as was given the first time, especially if the HCL stayed in remission for a long time. Sometimes the monoclonal antibody rituximab is given along with chemo.
In rare cases, HCL may not respond to chemo. Rituximab or interferon-alfa, a type of immunotherapy, may be helpful.
If a person is uncomfortable because of an enlarged spleen, surgery to remove the spleen (splenectomy) can often help relieve pain.
Like chronic lymphocytic leukemia, HCL can cause problems with low blood counts and infections. Treatment of these problems is discussed in Supportive Care in Chronic Lymphocytic Leukemia.
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Last Revised: January 18, 2023