What is the initial treatment for hairy cell leukemia?

Updated: Jan 16, 2019
  • Author: Sandy D Kotiah, MD; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

Answer

The purine analogues cladribine and pentostatin are first-line agents in the treatment of HCL. Cladribine is more commonly used because of ease of administration. [15]

  • Cladribine 0.09 mg/kg/day by continuous IV infusion for 7d (FDA approved) or  0.14 mg/kg/day IV over 2h or SC for 5d; 5-6 weekly doses of 0.14 mg/kg have also been studied [5] (cost, inconvenience, and adverse reactions less likely with SC; can use growth factors if febrile neutropenia develops) or

  • Pentostatin 4 mg/m2 IV bolus or over 30min every 2wk with 1.5 L of hydration for each dose for 3-6mo or

  • Interferon alfa 2b 2 million U/m2 SC 3 times per week for 12-18mo for relapsed or refractory HCL

  • Splenectomy (laparoscopic preferred) is considered for patients with bleeding from severe thrombocytopenia or failure to respond to systemic therapy; administer pneumococcal, meningococcal, and Haemophilusinfluenzae vaccines prior to surgery


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