How Do I Treat Hairy Cell Leukemia?
The goal of treatment for hairy cell leukemia (HCL) is to achieve complete remission. A complete remission means that hairy cells in the blood or bone marrow cannot be identified, also that the liver, lymph nodes, and spleen are normal sizes and finally that blood and bone marrow cell counts have returned to normal. Most people with hairy cell leukemia receive treatment at the time of diagnosis or at some point during the course of the disease. In a small percentage of cases, people do not need treatment immediately and they may choose to delay it until the signs and symptoms of the disease appear.
Cladribine is usually the first drug used in the treatment of hairy cell leukemia. It is administered by means of a needle in a vein, or intravenously (IV), for five to seven days in a row. About half of the patients treated with cladribine have a fever of approximately 100 °F (37.8 °C) during or immediately after treatment. Fever can occur when the amount of hairy cells in the blood, bone marrow and other parts of the body decreases. This fever related to the drug does not have to do with an infection. It usually stops after three to five days after the first injection. Patients may feel tired during the first weeks after the start of treatment.
Blood cell counts may be lower due to treatment, but eventually, improve and usually return to normal.
Approximately 85 percent of patients treated with cladribine achieve a complete remission and 10 percent have a partial response. Although minimal residual hairy cell disease can be detected with very sensitive techniques in the majority of patients achieving an apparently complete remission, long-term remissions are common.
Treatment For Patients Who Have A Relapse or Resistance To Treatment
Patients who do not respond to cladribine or who relapse after achieving remission are usually treated with pentostatin. Excellent response rates with pentostatin have been achieved in patients with hairy cell leukemia. It is administered intravenously (IV) week by week for three to six months. The administration of pentostatin usually takes around 20 minutes.
A patient may have a relapse after treatment with cladribine or pentostatin. However, the same patient could respond to the second course of treatment with the same drug. Another drug called interferon-alpha has also had the ability to destroy hairy cells and can be used in cases where neither cladribine nor pentostatin achieves a satisfactory response. Interferon can be administered three times a week by injection, for up to one year. It may be necessary to administer long-term maintenance therapy with interferon to keep the disease under control. Interferon can cause side effects that include fatigue, fever, and pain in the bones.
Surgical removal of the spleen (called splenectomy) was common before the availability of effective drugs for the treatment of hairy cell leukemia. Splenectomy is no longer considered a primary treatment for the disease.
Occasionally it may be necessary to perform a splenectomy in patients with an enlarged spleen who have not responded to treatment or who relapse after pharmacotherapy (treatment with medicines).
Stem cell transplantation uses stem cells obtained from the bone marrow or blood of a donor with an identical tissue type. This type of treatment is taken into account for selected patients. First, the patient receives intensive chemotherapy treatment, sometimes combined with radiation therapy, in an effort to eradicate leukemic cells. The normal development of blood cells in the bone marrow, which is also seriously affected by the treatment, is restored by transplanting the donor’s stem cells. This procedure may be useful in younger people who have a compatible donor and who do not respond to the chemotherapy.
Research on hairy cell leukemia in recent years has resulted in many new and emerging treatments that offer better treatment options to patients. These tests carried out according to rigorous guidelines can help medical professionals and researchers determine the beneficial and adverse effects of possible new treatments. Patients may have the opportunity to participate in clinical trials.
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