Types of treatment for hairy cell leukaemia

The treatment for HCL varies depending on

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

This depends on whether you have symptoms or not. If your doctor diagnosed your HCL through a routine blood test, and you don’t have any symptoms, you probably won’t need to start any treatment. Many people don’t need treatment for years. Starting treatment when you have no symptoms is unlikely to help your HCL. But your doctor will see you regularly and check your blood cell count. If your blood count changes, or if you develop symptoms of HCL, you will begin treatment.

If you have symptoms at diagnosis you will need to begin treatment. Like other types of leukaemia, HCL is a disease of remission and relapse. Remission is the name for the period when your leukaemia is controlled. During this time, you don’t need any treatment. With HCL, this can last for years.

If the disease comes back, it is called a relapse. If you relapse you will start treatment again. Many people with HCL will get further periods of remission with treatment. Generally speaking, the remissions tend to get shorter each time the HCL relapses and you have treatment again.

There are different treatments for HCL. You may need just one treatment, or a combination of treatments. There is detailed information about each of these treatments in this section of CancerHelp UK. The main treatment for hairy cell leukaemia is chemotherapy. You may also have surgery, interferon alpha or rituximab.

Chemotherapy

Chemotherapy is the main treatment for HCL. Over 9 out of 10 (90%) people will go into remission with chemotherapy. You may have

• Cladribine
• Pentostatin

You may have these drugs either as an outpatient or you may stay in hospital to have them. You usually only have one course of cladribine. If you are having pentostatin you have it every 2 weeks until you go into remission. You can find out more about these drugs and their side effects in the chemotherapy for HCL section.

Interferon

Interferon is a type of biological therapy. It is a natural substance that our bodies produce as part of the immune response. It can boost the immune system and help fight cancer. For HCL, it is not often used now because the newer chemotherapy drugs work so well. But we have left it on this page because you might have interferon if

• You can’t have chemotherapy
• Chemotherapy is no longer working
• You are getting repeated infections
• You have had it before and it worked

You can find out more about interferon for HCL in this section.

Surgery

Doctors don’t use surgery very often to treat HCL. It used to be common to remove the spleen because it became very enlarged and caused symptoms. But chemotherapy works so well now that this is rarely necessary. But some people might need to have their spleen removed 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

You can find out more about surgery for HCL in this section.

If your HCL comes back you are likely to need further treatment. Doctors call this 'second line' treatment. The choice of treatment will depend on how long your HCL was in remission and on which treatment you had before.

If your last treatment was more than 5 years ago, you might have the same treatment again. Most people have chemotherapy as their first treatment, and have chemotherapy again as a ‘second line’ treatment. This might be the same chemotherapy drug or a different one.

If it has been less than 3 years since your first treatment, your doctor may give you something different, such as interferon alpha. Recently, doctors have been giving a combination of chemotherapy (cladribine or pentostatin) and the biological therapy rituximab. There is more detailed information about treating hairy cell leukaemia that has come back in this section of CancerHelp UK.