Treatment if hairy cell leukaemia comes back

If your last treatment was more than 3 to 5 years ago, you might have the same treatment again. If it has been less than 3 years since you treatment, your doctor will probably use a different drug.

The treatment you have already had

Most people have one chemotherapy drug as their first treatment, and a different type of chemotherapy as a ‘second line’ treatment. This means that if you had cladribine treatment the first time, you might have pentostatin the second time.

If chemotherapy isn’t controlling the HCL, you will need a different treatment. Doctors call this 'chemotherapy resistant' or 'chemotherapy refractory' disease. Your doctor may give you the monoclonal antibody rituximab, or interferon.

Rituximab

Rituximab is a relatively new treatment for HCL, but has been in use for treating some types of lymphoma for a few years. Rituximab works by seeking out a protein that is found on some normal and leukaemic white blood cells, including hairy cell leukaemia cells. The protein is called CD20. Once it has found the CD20 positive cells, it sticks to them. This helps other immune system cells to find them and kill them.

For HCL, you usually have rituximab with chemotherapy - pentostatin or cladribine. This type of treatment is only used for HCL that has come back.

Rituximab does have some side effects. You are most likely to have side effects when you first have the drug. You may

• Have fever, chills and shivering
• Feel sick
• Develop an itchy rash
• Get a headache

A few people have wheezing and feel faint because their blood pressure drops. You are most likely to have one or more of these side effects in the first 2 hours after having the drug. Your doctor may give you other drugs beforehand (an antihistamine and a steroid) to try and prevent side effects. If you do have a reaction, your nurse may slow down your rituximab drip to help control it.

There is more information about the side effects of rituximab in the cancer drugs section.