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Chemotherapy for hairy cell leukaemia

Men and women discussing hairy cell leukaemia

This page tells you about chemotherapy treatment for hairy cell leukaemia (HCL). There is information about

 

A quick guide to what's on this page

Chemotherapy for hairy cell leukaemia

Chemotherapy means treatment with drugs that kill cancer cells. The drugs travel through the body in the bloodstream. Chemotherapy is the most common treatment for HCL. The drugs you are most likely to have are cladribine or pentostatin.

Cladribine

Most people have cladribine as an injection just below the skin every day for 5 days in a row. You can have the injections as an outpatient. Some people have cladribine for a week at a time, as a continuous drip. This means that you will have to stay in hospital. Most people have just one course of treatment with cladribine.

Pentostatin

You have pentostatin as an outpatient every 2 weeks, for as long as your doctor thinks you need it. Generally, the treatment lasts between 3 and 6 months. Each treatment takes around half an hour.

Side effects of chemotherapy

People don’t all have the same side effects with the same drug. Some people have very few side effects at all. Common side effects of these chemotherapy drugs include a fall in the number of blood cells, and feeling tired and run down. Some people get a rash or feel sick.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Treating hairy cell leukaemia section.

 

What chemotherapy is

Chemotherapy means treatment with cell killing (cytotoxic) drugs. The drugs work by disrupting the growth of cancer cells so that the cells die. The drugs travel through the body in the bloodstream.

 

Chemotherapy treatments for HCL

Chemotherapy is the most common treatment for HCL. You are most likely to have either Cladribine or Pentostatin. 

Cladribine (CDA)

You may have cladribine as an injection just below the skin every day for 5 days in a row. You may go to the hospital day unit for your injections. Or a district nurse can give them. Or your nurse can teach you to give them yourself, which means you can stay at home for your treatment. 

Some people have cladribine for a week at a time (7 days), into a vein as a continuous drip (infusion). This means that you will have to stay in hospital. Most people have just one course of treatment.

Doctors have recently been looking at other ways of giving cladribine including through a drip over a few hours.  

Pentostatin

You have pentostatin into a vein, as an outpatient every 2 weeks, until all signs of the leukaemia have gone or it is under control. The length of treatment varies from one person to another and depends on how your HCL responds. But generally, the treatment usually lasts between 3 to 6 months. Each treatment takes around half an hour.

If you don't go into remission

When your full blood count is normal again, you will have a bone marrow test to find out how well the treatment is working. If you are having cladribine, this is usually about 4 to 6 months after you finish treatment. If you are having pentostatin, it is usually after 8 or 9 courses of treatment. If the bone marrow test shows you have not gone into remission with your first chemotherapy treatment, you may have another course of chemotherapy. Your doctor may also suggest adding in the monoclonal antibody rituximab.

If you have other medical conditions or are not well enough to have chemotherapy or rituximab your doctor may recommend interferon

 

Side effects of chemotherapy

Chemotherapy affects different people in different ways. People don’t always have the same side effects with the same drug. Some people have very few side effects at all. It is not possible to tell how you will react until you have had a particular drug.

Common side effects of chemotherapy drugs for hairy cell leukaemia include

Low blood cell counts

Throughout your course of chemotherapy, you will have regular blood tests to make sure your blood cell counts are not too low. If your red blood cell count is low, you may need a blood transfusion. If your white blood cell count is low, you are more at risk of picking up infections.

You may need antibiotics to try to prevent infection. Your doctor will always want you to have blood tests before each chemotherapy treatment. If your white blood cell count is too low, your doctor may delay your next chemotherapy treatment until your white cells have recovered. Both pentostatin and cladribine increase your risk of infection for months after your treatment. You may have a low white cell count for up to a year. If you have continuing infections, you may have injections of growth factors. These boost your immune system. Growth factor injections work by stimulating the bone marrow to make more blood cells.

Remember to contact your doctor or chemotherapy nurse if you think you have an infection. If you have a temperature of 38°C or higher, let the hospital know at once.

Feeling tired and run down

Some people are able to carry on almost as normal when they are having chemotherapy. But others become very tired – this is called fatigue. As you go through your course of chemotherapy, you are more likely to feel tired and run down.

If this is happening to you, try to take things more slowly. If you feel like having a lie down or putting your feet up, you probably need to do just that. It is best not to struggle to cope with everything you did before having your treatment. You will probably feel better sooner if you don't overdo it.

There is more information about how to cope with fatigue in the section about coping physically with cancer.

Other possible side effects include

The links above take you to information about these side effects, and suggestions for advice on how to deal with them.

 

Long term side effects of chemotherapy

Some doctors are concerned that people having treatment for HCL may have an increased risk of developing a second cancer years later. This may be because people who develop HCL have a higher risk of getting another cancer anyway. Several studies have looked into this. The general conclusion is that people with HCL are not more likely to develop a second cancer. But we need further research to be absolutely sure.

 

Dietary or herbal supplements and chemotherapy

We don't yet know much scientifically about how some nutritional or herbal supplements may interact with chemotherapy. Some could be harmful. It is very important to let your doctors know if you take any supplements. Or if you are prescribed remedies by alternative or complementary therapy practitioners.

Talk to your specialist about any other tablets or medicines you take while you are having active treatment. There is information about the safety of herbal, vitamin and diet supplements in the complementary therapies section.

Some studies seem to suggest that fish oil preparations may reduce the effectiveness of chemotherapy drugs. If you are taking or thinking of taking these supplements talk to your doctor to find out whether they could affect your treatment.

 

More about chemotherapy

There is detailed information about chemotherapy in our main chemotherapy section. If you would like more information about chemotherapy, talk to your chemotherapy nurse or contact our cancer information nurses. They would be happy to help.

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Updated: 2 April 2015