Chemotherapy for hairy cell leukaemia

Chemotherapy uses anti cancer (cytotoxic) drugs to destroy cancer cells. The drugs circulate throughout the body in the bloodstream.

Chemotherapy is the main treatment for hairy cell leukaemia. The most common chemotherapy drugs are cladribine or pentostatin. 

When you have it

You’re likely to have chemotherapy as your main treatment when you are first diagnosed. You usually have one chemotherapy drug, on its own.

You might need further chemotherapy if your leukaemia comes back (relapses). You might have chemotherapy on its own or combined with a targeted drug called rituximab.

Types of chemotherapy

The two main chemotherapy drugs for hairy cell leukaemia are clardibine and pentostatin.

Cladribine (CDA)

You usually have cladribine as an injection just below the skin every day for 5 days in a row.

Some people have cladribine into a vein as a continuous drip (infusion) for 7 days.

There are other ways of having cladribine, including as an infusion over 2 hours for 5 days, or once a week for 6 weeks. Your doctor will talk to you about how you will have it. 

Most people have just one course of cladribine.


You have pentostatin into a vein 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 the hairy cell leukaemia responds.

Generally the treatment lasts between 3 to 6 months. 

Other chemotherapy drugs

You might have a different chemotherapy treatment if the first treatment doesn't work. Or if your leukaemia comes back (relapses) after treatment.You often have this second line chemotherapy combined with the targeted cancer drug rituximab. 

You might have a different chemotherapy drug called bendamustine.

How you have it

You might have chemotherapy as an injection under your skin (subcutaneous injection), or as a drip into your bloodstream (infusion).

Injection under the skin

You usually have subcutaneous injections into the stomach, thigh or top of your arm.

The video below shows you how to give an injection just under your skin. 

Into your bloodstream

You have the treatment through a drip into your arm. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

Diagram showing a cannula

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Where you have chemotherapy

If you have cladribine as an injection under your skin, you might go to the hospital day unit for your injections. Or a district nurse can give them to you at home.

Your nurse might teach you to give them yourself.

If you have chemotherapy as a drip into your bloodstream, you usually have this in hospital. You might have this as an inpatient on the ward, or as an outpatient in the cancer day clinic.

Before you start chemotherapy

You need to have blood tests to make sure it’s safe to start treatment. You usually have these a few days before or on the day you start treatment. You have blood tests before each round or cycle of treatment.

Side effects

Common side effects include:

  • increased risk of infections
  • feeling very tired (fatigue)
  • bleeding and bruising easily
  • feeling or being sick (nausea and vomiting)
  • a skin rash
Contact the doctor or nurse immediately if you have any signs of infection such as a temperature below 36C or higher than 37.5C, or you are generally feeling unwell. Infections can make you very unwell very quickly.

Side effects depend on:

  • which drug you have
  • how much of the drug you have
  • how you react

Tell your treatment team about any side effects that you have.

When you go home

Chemotherapy for hairy cell leukaemia can be difficult to cope with. Tell your doctor or nurse about any problems or side effects that you have. Your nurse will give you telephone numbers to call if you have any problems at home.

If you have any questions about chemotherapy for hairy cell leukaemia, you can call Cancer Research UK's information nurses on freephone 0808 800 4040, 9am to 5pm, Monday to Friday.

  • Electronic Medicines Compendium
    Accessed November 2020

  • 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 Haematology 2020, Volume 191, pages 730 – 737

  • Pan-London Haemato-Oncology Clinical Guidelines Lymphoid Malignancies Part 5: Less Common Lymphoid Malignancies
    London Cancer Alliance (LCA), 2020

  • Oncology/Haematology 24 Hour Triage Rapid Assessment and Access Toolkit (version 1.2)
    UK Oncology Nursing Society, December 2016

  • The role of temperature in the detection and diagnosis of neutropenic sepsis in adult solid tumour cancer patients receiving chemotherapy 
    C Warnock
    European Journal of Oncology Nursing, 2018. Volume 37, pages 12 to 18

Last reviewed: 
22 Oct 2021
Next review due: 
22 Oct 2024

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