Hairy Cell Leukemia Treatment (PDQ®)–Patient Version
General Information About Hairy Cell Leukemia
- Hairy cell leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).
- Leukemia may affect red blood cells, white blood cells, and platelets.
- Signs and symptoms of hairy cell leukemia include infections, tiredness, and pain below the ribs.
- Tests that examine the blood and bone marrow are used to diagnose hairy cell leukemia.
- Certain factors affect treatment options and prognosis (chance of recovery).
Hairy cell leukemia is a type of cancer in which the bone marrow makes too many lymphocytes (a type of white blood cell).
Hairy cell leukemia is a cancer of the blood and bone marrow. This rare type of leukemia gets worse slowly or does not get worse at all. The disease is called hairy cell leukemia because the leukemia cells look "hairy" when viewed under a microscope.
Leukemia may affect red blood cells, white blood cells, and platelets.
A myeloid stem cell becomes one of three types of mature blood cells:
In hairy cell leukemia, too many blood stem cells become lymphocytes. These lymphocytes are abnormal and do not become healthy white blood cells. The abnormal lymphocytes are also called leukemia cells. The leukemia cells can build up in the blood and bone marrow so there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection, anemia, and easy bleeding. Some of the leukemia cells may collect in the spleen and cause it to swell.
Signs and symptoms of hairy cell leukemia include infections, tiredness, and pain below the ribs.
Tests that examine the blood and bone marrow are used to diagnose hairy cell leukemia.
- Complete blood count (CBC): A procedure in which a sample of blood is drawn and checked for the following:
- Peripheral blood smear: A procedure in which a sample of blood is checked for cells that look "hairy," the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
- Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease.
- Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of the cells, such as size, shape, and the presence of tumor (or other) markers on the cell surface. The cells from a sample of a patient’s blood, bone marrow, or other tissue are stained with a fluorescent dye, placed in a fluid, and then passed one at a time through a beam of light. The test results are based on how the cells that were stained with the fluorescent dye react to the beam of light. This test is used to help diagnose and manage certain types of cancers, such as leukemia and lymphoma.
- Bone marrow aspiration and biopsy: The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for signs of cancer.
- Immunophenotyping: A laboratory test that uses antibodies to identify cancer cells based on the types of antigens or markers on the surface of the cells. This test is used to help diagnose specific types of leukemia.
- Cytogenetic analysis: A laboratory test in which the chromosomes of cells in a sample of blood or bone marrow are counted and checked for any changes, such as broken, missing, rearranged, or extra chromosomes. Changes in certain chromosomes may be a sign of cancer. Cytogenetic analysis is used to help diagnose cancer, plan treatment, or find out how well treatment is working.
- BRAF gene testing: A laboratory test in which a sample of blood or tissue is tested for certain changes in the BRAF gene. A BRAF gene mutation is often found in patients with hairy cell leukemia.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A CT scan of the abdomen may be done to check for swollen lymph nodes or a swollen spleen.
Certain factors affect treatment options and prognosis (chance of recovery).
The treatment options depend on the following:
- The number of hairy (leukemia) cells and healthy blood cells in the blood and bone marrow.
- Whether the spleen is swollen.
- Whether there are signs or symptoms of leukemia, such as infection.
- Whether the leukemia has recurred (come back) after previous treatment.
The prognosis depends on the following:
- Whether the hairy cell leukemia does not grow or grows so slowly it does not need treatment.
- Whether the hairy cell leukemia responds to treatment.
Treatment often results in a long-lasting remission (a period during which some or all of the signs and symptoms of the leukemia are gone). If the leukemia returns after it has been in remission, retreatment often causes another remission.
Stages of Hairy Cell Leukemia
- There is no standard staging system for hairy cell leukemia.
- Sometimes hairy cell leukemia does not respond to treatment or comes back after treatment.
There is no standard staging system for hairy cell leukemia.
In untreated hairy cell leukemia, some or all of the following conditions occur:
Sometimes hairy cell leukemia does not respond to treatment or comes back after treatment.
Treatment Option Overview
- There are different types of treatment for patients with hairy cell leukemia.
- The following types of treatment are used:
- Watchful waiting
- Targeted therapy
- New types of treatment are being tested in clinical trials.
- Treatment for hairy cell leukemia may cause side effects.
- Patients may want to think about taking part in a clinical trial.
- Patients can enter clinical trials before, during, or after starting their cancer treatment.
- Follow-up tests may be needed.
There are different types of treatment for patients with hairy cell leukemia.
Different types of treatment are available for patients with hairy cell leukemia. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
The following types of treatment are used:
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Cladribine and pentostatin are anticancer drugs commonly used to treat hairy cell leukemia. These drugs may increase the risk of other types of cancer, especially Hodgkin lymphoma and non-Hodgkin lymphoma. Long-term follow up for second cancers is very important.
See Drugs Approved for Hairy Cell Leukemia for more information.
Immunotherapy is a treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer.
See Drugs Approved for Hairy Cell Leukemia for more information.
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells.
- Monoclonal antibody therapy: Monoclonal antibodies are immune system proteins made in the laboratory to treat many diseases, including cancer. As a cancer treatment, these antibodies can attach to a specific target on cancer cells or other cells that may help cancer cells grow. The antibodies are able to then kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.
Rituximab is a type of monoclonal antibody that may be used to treat certain patients with hairy cell leukemia.
Other types of targeted therapies are being studied in the treatment of hairy cell leukemia, including:
See Drugs Approved for Hairy Cell Leukemia for more information.
New types of treatment are being tested in clinical trials.
Information about clinical trials is available from the NCI website.
Treatment for hairy cell leukemia may cause side effects.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCI’s clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
Treatment of Hairy Cell Leukemia
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of hairy cell leukemia may include the following:
- Watchful waiting when possible.
- Vemurafenib (or other BRAF inhibitors) with or without rituximab.
- Immunotherapy (recombinant interferon alpha-2b).
- Moxetumomab pasudotox-tdfk.
- Cladribine with or without rituximab.
- Repeat treatment with cladribine or pentostatin.
You and your doctor will discuss what treatment plan is best for you.
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
To Learn More About Hairy Cell Leukemia
For more information from the National Cancer Institute about hairy cell leukemia, see the following:
For general cancer information and other resources from the National Cancer Institute, see the following:
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This PDQ cancer information summary has current information about the treatment of hairy cell leukemia. It is meant to inform and help patients, families, and caregivers. It does not give formal guidelines or recommendations for making decisions about health care.
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Clinical Trial Information
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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PDQ® Adult Treatment Editorial Board. PDQ Hairy Cell Leukemia Treatment. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/types/leukemia/patient/hairy-cell-treatment-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389248]
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