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Hairy Cell Leukemia
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of hairy cell leukemia.
Hairy Cell Leukemia
General Information About Hairy Cell Leukemia
Hairy cell leukemia is a type of cancer in which
the bone
marrow makes too many lymphocytes (a type of white blood cell).
Hairy cell leukemia is
a cancer of the blood and bone marrow . This rare type of leukemia gets worse slowly or not at all. The disease is called hairy cell leukemia
because the leukemia cells look "hairy" when viewed
under a microscope.
Normally,
the bone marrow produces stem cells (immature cells ) that develop into mature blood cells. There are 3 types of mature blood cells:
In hairy cell leukemia, too many stem cells develop into a type of white blood cell called lymphocytes . These lymphocytes may also be called leukemic cells. There are 3 types of lymphocytes.
In hairy cell leukemia, the B lymphocytes do not work normally. Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets. This may cause infection, anemia , and easy bleeding. Some of the leukemia cells may collect in the spleen and cause it to swell.
This summary is about hairy cell leukemia.
Refer to the following PDQ summaries for information about other types of leukemia:
- Adult Acute Lymphoblastic Leukemia Treatment.
- Childhood Acute Lymphoblastic Leukemia Treatment.
- Chronic Lymphocytic Leukemia Treatment.
- Adult Acute Myeloid Leukemia Treatment.
- Childhood Acute Myeloid Leukemia/Other Myeloid Malignancies Treatment.
- Chronic Myelogenous Leukemia Treatment.
Gender and age may affect the risk of developing hairy cell leukemia.
The cause of hairy cell leukemia is unknown. It occurs more often in older men.
Possible signs of hairy cell leukemia include tiredness, infections, and pain below the ribs.
These and other symptoms may be caused by hairy cell leukemia. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following
problems occur:
- Weakness or feeling tired.
- Fever or frequent infections.
- Easy bruising or bleeding.
- Shortness of breath.
- Weight loss for no known reason.
- Pain or a feeling of fullness below the ribs.
- Painless lumps in the neck, underarm, stomach , or groin .
Tests that examine the blood and bone marrow are used to detect
(find) and diagnose hairy cell leukemia.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as a swollen spleen, lumps, or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood
count (CBC): A procedure in which a sample of blood is drawn and
checked for the following:
- The number of red blood cells, white blood cells, and
platelets.
- The amount of hemoglobin (the protein that carries oxygen) in
the red blood cells.
- The portion of the sample made up of red blood
cells.
- Peripheral blood smear : A procedure in which a sample of blood is checked for cells that look "hairy," the number and kinds of white blood cells, the number of platelets, and changes in the shape of blood cells.
- Bone marrow
biopsy : The removal of a small piece of bone and bone marrow by inserting a needle into the hipbone or breastbone. A pathologist views both the bone and bone marrow samples under a microscope to look for signs of cancer.
- Immunophenotyping : A test in which the cells in a sample of blood or bone marrow are looked at under a microscope to check the pattern of proteins that are on the surface of the cells. Hairy cells have a certain pattern.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography. A CT scan of the abdomen may be done to check for swollen lymph nodes or a swollen spleen.
Certain factors affect treatment options and prognosis (chance
of recovery).
The treatment options may depend on the following:
- The number of hairy (leukemia) cells and healthy blood cells in the blood and bone marrow.
- Whether the spleen is swollen.
- Whether there are symptoms of leukemia, such as infection.
- Whether the leukemia has recurred (come back) after previous treatment.
The prognosis (chance of recovery) depends on the following:
- Whether the hairy cell leukemia does not grow or grows so slowly it does not need treatment.
- Whether the hairy cell leukemia responds to treatment.
Treatment often results in a long-lasting remission (a period during which some or all of the signs and symptoms of the leukemia are gone). If the leukemia returns after it has been in remission, retreatment often causes another remission.
Stages of Hairy Cell Leukemia
Staging is the process
used to find out how far the cancer has spread. There is no standard staging
system for hairy cell leukemia . The
disease is grouped as untreated, progressive , or refractory .
Untreated hairy cell leukemia
The hairy cell leukemia is newly diagnosed and has not been treated except to relieve symptoms such as weight loss and infections . In untreated hairy cell leukemia, some or all of the following conditions occur:
Progressive hairy cell leukemia
In progressive hairy cell leukemia , the leukemia has been treated with either chemotherapy or splenectomy (removal of the spleen) and one or both of the following conditions occur:
Relapsed or Refractory Hairy Cell Leukemia
Relapsed hairy cell leukemia has come back after treatment. Refractory hairy cell leukemia has not responded to treatment.
Treatment Option Overview
There are different types of treatment for patients with hairy
cell leukemia.
Different types of treatment are available for patients with
hairy cell leukemia . Some treatments
are standard (the currently used treatment), and some are being tested in
clinical trials . Before starting
treatment, patients may want to think about taking part in a clinical trial. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer .
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web
site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Four types of standard treatment are used:
Watchful waiting
Watchful waiting is closely monitoring a patient's condition, without giving any treatment until symptoms appear or change.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells , either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the spinal column , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Cladribine and pentostatin are anticancer drugs commonly used to treat hairy cell leukemia.
Biologic therapy
Biologic
therapy is a cancer treatment that uses the patient’s immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body’s natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Interferon alfa is a biologic agent commonly used to treat hairy cell leukemia. For relapsed or refractory patients, a biologic agent called rituximab may be used.
Surgery
Splenectomy is a surgical procedure to remove the spleen .
Other types of treatment are being tested in clinical trials.
These include the following:
Stem cell transplant
Stem cell transplant is a method of giving chemotherapy and replacing blood-forming cells destroyed by the cancer or cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of a brother or sister and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion . These reinfused stem cells grow into (and restore) the body’s blood cells.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the
NCI Web
site.
Treatment Options for Hairy Cell Leukemia
Untreated Hairy Cell Leukemia
If the patient's blood cell counts are not too low and there are no symptoms , treatment may not be needed and the patient is carefully watched for changes in his or her condition. If blood cell counts become too low or symptoms appear, initial treatment may include the following:
Progressive Hairy Cell Leukemia
Treatment for progressive hairy cell leukemia may include the
following:
Relapsed or Refractory Hairy Cell Leukemia
Treatment of relapsed or refractory hairy cell leukemia may include the
following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the
NCI Web
site.
Changes to This Summary (05/12/2005)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
To Learn More
Call
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The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
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- Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
2005-05-12
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