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Decisions about your treatment

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. Other treatments include:

  • a targeted drug such as rituximab, or a similar drug
  • an immunotherapy treatment called interferon
  • surgery to remove your spleen

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 do I start treatment?

You usually start treatment straight away if you have symptoms when you are diagnosed. 

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 careful monitoring with tests and check ups every 3 to 6 months. This is called watch and wait.

If your blood count changes or if you develop symptoms, you begin treatment.

The aim of treatment is to get rid of the leukaemia cells (remission). 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

Chemotherapy is the use of anti cancer drugs to destroy cancer cells. It is the main treatment for hairy cell leukaemia. More than 8 out of 10 people (80%) will go into remission with chemotherapy.

You usually have the drug cladribine or pentostatin. You might have this treatment as an outpatient or you might stay in hospital to have it. 

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 targeted drug rituximab.

Targeted cancer drugs and immunotherapy

Targeted cancer drugs work by targeting the differences in cancer cells that help them to grow and survive. Other drugs help the immune system to attack the cancer.

Rituximab

Rituximab works by seeking out and sticking to a protein that is found on leukaemia cells. This makes it easier for the cells of the immune system to pick out the marked cells and kill them. Because of the way it works, rituximab is also called a targeted immunotherapy.

You might have rituximab for hairy cell leukaemia if:

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

Interferon

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

Surgery

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.

Information and help