What is hairy cell leukaemia?

Hairy cell leukaemia (HCL) is a rare type of chronic leukaemia. It develops slowly from white cells called B lymphocytes. Doctors look at the cells under a microscope. The cells have hair-like outgrowths on their surfaces. This is where the name hairy cell comes from.

Hairy cell leukaemia usually develops slowly. It can be kept under control for many years with treatment. 

You might hear hairy cell leukaemia called 'classic' or 'classical' hairy cell leukaemia. This is because there's another type of leukaemia called hairy cell leukaemia variant (HCL-V).  Doctors used to think HCL-V was a rare type of hairy cell leukaemia. But they now consider it to be a different condition.

What is leukaemia?

Leukaemia is a blood cancer. Your bone marrow makes blood cells. The bone marrow is the soft inner part of some of your bones.

In most types of leukaemia, abnormal white blood cells are made in the bone marrow. These cells can get into the bloodstream and circulate round the body. They do not develop properly and so do not work normally. For example, they don't give you the protection from infection that they should. There are too many of these abnormal white blood cells. They might stop the bone marrow producing enough healthy blood cells.

They can also build up in the lymph nodes and spleen and cause swelling. 

There are different types of leukaemia. They are divided into two main groups:

  • acute leukaemia
  • chronic leukaemia

Acute and chronic leukaemia

Acute leukaemias tend to develop quickly and get rapidly worse if they are not treated. Chronic leukaemias develop slowly and tend to get worse slowly, over a long time. 

In chronic leukaemia the white blood cells are almost fully developed. But they are not completely normal. They still work, but not as well as they should do at fighting infection. Your body makes too many of these abnormal white blood cells. 

The blood and blood cells

 To understand the effects of any type of leukaemia it helps to know more about blood cells. 

How you make blood cells

Your body makes blood cells in the bone marrow. The bone marrow is the soft inner part of your bones. You make blood cells in a controlled way, as your body needs them.

All blood cells start as the same type of cell, called a stem cell. The stem cells then develop into:

  • myeloid stem cells become white blood cells called monocytes and neutrophils (granulocyte), red blood cells and platelets
  • lymphoid stem cells, which become white blood cells called lymphocytes

The diagram below helps to explain this.

A simplified diagram showing how blood cells are made

The type of chronic leukaemia you have tells you which type of white blood cell has become cancerous. In hairy cell leukaemia, it is the white cells called B lymphocytes that become cancerous. 

Diagram showing the cells hairy cell leukaemia affects

White blood cells (leucocytes)

There are several different types of white cells in the blood. There are more of some types than others. They are an important part of the immune system, helping the body to fight infection. These blood cells can be made very quickly and generally have a short life. Some only live for a few hours, others for a few days.

Red blood cells (erythrocytes)

Red blood cells carry oxygen from the lungs around the body to the tissues. They give the blood its red colour.

Platelets (thrombocytes)

Platelets are very important in blood clotting. They clump together to form a plug if bleeding occurs. Then they release other chemicals that help the blood to clot and the blood vessel to be repaired.

How leukaemia might affect you

Leukaemia causes your body to make abnormal white blood cells and they don’t work properly.

Too many white blood cells can overcrowd the bone marrow. So there is not enough space for other types of blood cells. Then you might have lower than normal levels of red blood cells and platelets.

Abnormal white blood cells

The body needs normal white bloods to help fight infection.

The abnormal white blood cells make you more likely to get infections. And it is harder to get over the infections.

Abnormal white blood cells can also build up in other parts of the body, such as the spleen and lymph nodes, or the liver. This can make your tummy (abdomen) swell and feel uncomfortable. The leukaemia cells can also spread to the brain in some people.

Fewer red blood cells (anaemia)

You might feel very tired and breathless.

Fewer platelets

A low platelet count can mean you bruise or bleed more easily. 

You might have bruising, nosebleeds or bleeding gums. 

Other types of chronic leukaemia

The two most common types of chronic leukaemia are:

  • chronic myeloid leukaemia (CML)
  • chronic lymphocytic leukaemia (CLL)

The difference is the type of white blood cell that has become cancerous.

Hairy cell leukaemia variant (HCL-V) is a separate type of leukaemia. It is different to the typical or classic hairy cell leukaemia.

In CLL the abnormal cells develop from the lymphoid blood stem cells. The cancerous white blood cells are B lymphocytes, also called B cells. 

In CML, the abnormal cells develop from the myeloid blood stem cells. So the cancerous white blood cells are myelocytes. These cells are sometimes called granulocytes.

Doctors used to think HCL-V was a rare type of hairy cell leukaemia. But they now consider it to be a completely different condition.

HCL-V and classic hairy cell leukaemia are both chronic leukaemias. They develop slowly from cells called B lymphocytes. 

HCL-V cells are usually smaller than classic hairy leukaemia cells. They have different genetic material in the cells. And they respond differently to treatment.

How common is hairy cell leukaemia?

Hairy cell leukaemia is very rare. It is estimated that around 210 people are diagnosed with hairy cell leukaemia in the UK each year.  It is more common in men than women.

  • Haematological Malignancy Research Network
    (Estimated by applying 2010-2016 HMRN incidence age and sex specific rates to 2016 ONS mid-year UK population estimates.) 
    Accessed July 2021

  • Cancer and its management (7th edition)
    J Tobias and D Hochhauser
    Wiley-Blackwell, 2015

  • Guideline for the diagnosis and management of hairy cell leukaemia (HCL) and hairy cell variant (HCL-V)
    N Parry Jones and others
    British Journal of Haematiology 2020, Volume 191, pages 730 - 737

  • Principles and practice of oncology (10th edition)
    VT De Vita, S Hellman and SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

Last reviewed: 
16 Jul 2021
Next review due: 
18 Jul 2024

Related links