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Hairy cell leukemia (HCL) tends to grow slowly. People with HCL who aren't having symptoms often don't need to be treated right away, but they do need to be watched carefully.

If you have HCL, you will see your cancer care team every few months to check for signs that the HCL is growing and to see if it's causing any problems (like low blood counts, fatigue, or an enlarged spleen).

Some people with HCL live for many years without having symptoms or needing treatment.

When does hairy cell leukemia (HCL) need to be treated?

Treatment may be advised if you have low blood cell counts, recurrent infections, an enlarged spleen or lymph nodes, or other bothersome symptoms.

Treatment doesn't cure HCL, but it can help with symptoms, stop the HCL from progressing, and help you live longer.

Which treatments are used for hairy cell leukemia (HCL)?

The first treatment for HCL is most often chemotherapy (chemo) with either cladribine (2-CdA) or pentostatin. Sometimes the monoclonal antibody rituximab is given after chemo.

HCL usually responds well to these drugs, and the responses often last for many years.

If the leukemia comes back at some point, it can often be treated with the same drug again, especially if the HCL stayed in remission for a long time (typically at least 2 years). If one chemo drug doesn't work, another can be tried.

In rare cases where HCL doesn't respond to chemo, or if the response to treatment doesn't last long, other types of medicines might be tried.

Targeted drugs known as BRAF inhibitors might be an option. This could include vemurafenib (sometimes with rituximab) or dabrafenib (plus trametinib).

BTK inhibitors are another type of targeted drug that might also be an option, as might rituximab alone or peginterferon-alfa, a type of immunotherapy. (To learn more about treatment with peginterferon-alfa, see Cytokines and Their Side Effects.)

If you are uncomfortable because of an enlarged spleen, surgery to remove your spleen (splenectomy) can often help relieve pain.

Treating other problems caused by hairy cell leukemia (HCL)

Like chronic lymphocytic leukemia (CLL), HCL can cause low blood counts and infections. Treatment of these problems is discussed in Supportive or Palliative Care for Chronic Lymphocytic Leukemia.