Types of treatment for hairy cell leukaemia

The treatment for HCL varies depending on

• How far your leukaemia has developed
• Your symptoms
• Your general health
• Your age and level of fitness

If you have symptoms at diagnosis you will need to begin treatment. If you don’t have any symptoms, you probably won’t need to start treatment. Some people don’t need treatment for years. Starting treatment when you have no symptoms is unlikely to help your HCL. If your blood count changes, or if you develop symptoms of HCL, you will begin treatment.

HCL is a disease of remission and relapse. Treatment can get the leukaemia into remission, which means that the leukaemia has disappeared completely or is under control. During this time, you don’t need any treatment. With HCL, remission can last for years. If the disease becomes active again, it is called a relapse and you will start treatment again. Many people with HCL will have years of remission with further treatment.

There are different treatments for HCL. You may need just one treatment, or a combination of treatments. There is detailed information about each of these treatments in this section. The main treatment for hairy cell leukaemia is chemotherapy. You may also have rituximab, surgery,or interferon alpha.

Chemotherapy

Chemotherapy is the main treatment for HCL. Over 9 out of 10 (90%) people will go into remission with chemotherapy. You may have

• Cladribine
• Pentostatin

You may have these drugs as an outpatient or you may stay in hospital to have them. You usually only have one course of cladribine. If you are having pentostatin you have it every 2 weeks until you go into remission. You can find out more about these drugs and their side effects in the chemotherapy for HCL section.

If your leukaemia does not go into remission your doctor may suggest adding the biological therapy rituximab to the chemotherapy.

Rituximab

Rituximab is a type of treatment called a monoclonal antibody. Rituximab works by seeking out a protein that is found on normal and leukaemic white blood cells (lymphocytes). Once it has found the lymphocytes, it sticks to them. The immune system then targets the cells and kills them. 

For HCL, you may have rituximab if

• Chemotherapy is not controlling the leukaemia
• The leukaemia has come back after chemotherapy treatment

You can find out more about rituximab and its side effects in this section.

Surgery

Doctors don’t use surgery very often to treat HCL. It used to be common to remove the spleen because it became very enlarged and caused symptoms. But chemotherapy works so well now that this is rarely necessary. But some people might need to have their spleen removed if it

• Is so large it is causing discomfort or pain
• Is destroying too many red blood cells or platelets
• Has not shrunk after chemotherapy

You can find out more about surgery for HCL in this section.

Interferon

Interferon is a type of biological therapy. It is a natural substance that our bodies produce as part of the immune response. It can boost the immune system and help fight cancer. For HCL, it is not often used now because the newer chemotherapy drugs work so well. But we have left it on this page because you might have interferon if 

• You can't have chemotherapy or rituximab
• Chemotherapy or rituximab is no longer working

You can find out more about interferon for HCL in this section.

If your HCL comes back you are likely to need further treatment. Doctors call this second line treatment. The choice of treatment will depend on how long your HCL was in remission and on which treatment you had before.

In this section there is information about treatment when HCL comes back.