How is refractory hairy cell leukemia (HCL) treated?

Updated: Sep 16, 2018
  • Author: Emmanuel C Besa, MD; Chief Editor: Koyamangalath Krishnan, MD, FRCP, FACP  more...
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For patients with hairy cell leukemia that is refractory to cladribine, or if relapse occurs after two cycles of cladribine, the authors recommend treatment with pentostatin, 4 mg/m2 intravenously every 2 weeks for 3-6 months. [34]  Interferon alfa at 2 million U/m2 subcutaneously 3 times a week for 12-18 months can also be used to salvage relapsed or refractory hairy cell leukemia.

Another option for relapsed or refractory hairy cell leukemia is moxetumomab pasudotox (Lumoxiti), an anti-CD22 recombinant immunotoxin approved by the US Food and Drug Administration (FDA) in September 2018. Approval was based on efficacy and safety data from a single-arm, open-label phase III clinical trial in 80 patients. In this trial, the durable complete response (CR) rate was 30%, the CR rate was 41%, and the objective response rate (CR and partial response) was 75%. Also, 80% of patients achieved hematologic remission. [35]

Hyperuricemia may occur during therapy in patients with hairy cell leukemia who have leukocytosis and high tumor burden. Add allopurinol at 300 mg per day orally.

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