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Decisions about your treatment

Find out how your doctor decides which treatment you need and about the types of treatment you might have.

There are different treatments for hairy cell leukaemia. You might need just one treatment or a combination of treatments. 

The main treatment for hairy cell leukaemia is chemotherapy. You might also have:

  • rituximab – a biological therapy
  • surgery to remove your spleen
  • interferon – a biological therapy (but this is rare)

Making decisions

The treatment you have depends on:

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

When to start treatment

You start treatment straight away if you have symptoms when you are diagnosed with hairy cell leukaemia.

If you don’t have any symptoms, you probably won’t need to start treatment. This is because it's unlikely to help your leukaemia. Some people don’t need treatment for years but you have tests and check ups every 3 to 6 months.

If your blood count changes or if you develop symptoms, you begin treatment. Treatment can get the leukaemia into remission, which means that the leukaemic cells have disappeared or are under control. During this time, you don’t need any treatment.

With hairy cell leukaemia, remission can last for years. If the leukaemia becomes active again, it is called a relapse and you have treatment again. Most people then have more years of remission.


Chemotherapy is the main treatment for hairy cell leukaemia. More than 8 out of 10 people (80%) will go into remission with chemotherapy. You might have treatment with a drug called cladribine. Or you might have a drug called pentostatin.

You might have these treatments as an outpatient or you might stay in hospital to have them.

You might have one course of cladribine over 5 to 7 days. Or you might have it once a week for 6 weeks.

If you are having pentostatin, you have it every 2 weeks until you go into remission.

Your doctors and nurses will regularly check your blood cell levels (blood counts) during and after treatment.

When your full blood count is normal again, you have a bone marrow test to find out how well the treatment is working. This is usually about 4 to 6 months after having cladribine. You have it after 8 or 9 courses of pentostatin.

If the bone marrow test shows you haven't gone into remission, you might have another course of chemotherapy. You might also have the biological therapy drug rituximab.

Biological therapies

Biological therapies are drugs that change the way cells work and help the body control the growth of cancer. Some seek out and destroy cancer cells. Others help the body attack the cancer.


Rituximab works by seeking out and sticking to a protein that is found on normal white blood cells and leukaemia cells. The immune system is then able to pick out these cells and kill them.

You might have rituximab for hairy cell leukaemia if:

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


Interferon is a natural substance that our bodies produce as part of the immune response. It can boost the immune system and help fight cancer.

Doctors don’t often use interferon for hairy cell leukaemia because newer chemotherapy drugs work so well.

You might have interferon if:

  • you can't have chemotherapy or rituximab
  • chemotherapy or rituximab is no longer working
  • you are pregnant or have very low levels of neutrophil blood cells


Doctors don't use surgery very often to treat hairy cell leukaemia. They might remove your spleen if it becomes bigger and causes symptoms. But as chemotherapy works so well this is rarely necessary.

You might have surgery to remove your spleen 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

If hairy cell leukaemia comes back

You are likely to need further treatment if your hairy cell leukaemia comes back. This is called second line treatment.

The choice of treatment will depend on how long your leukaemia was in remission and on which treatment you had before.

Clinical trials

Your doctor might ask if you’d like to take part in a clinical trial. Doctors and researchers do trials to make existing treatments better and develop new treatments.

Last reviewed: 
02 Apr 2015
  • Cancer: Principles and Practice of Oncology (10th edition)
    VT DeVita , TS Lawrence, SA Rosenberg
    Lippincott, Williams and Wilkins, 2015

  • Revised guidelines for the diagnosis and management of hairy cell leukaemia and hairy cell leukaemia variant
    G Jones and others
    British Journal of Haematology, 2012. Volume 156, Issue 2

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