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Hairy cell leukaemia

Last reviewed: 22 Aug 2025
Last updated: 25 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal fullness or discomfort
  • splenomegaly
Full details

Other diagnostic factors

  • weakness and fatigue
  • unexplained weight loss
  • bruising and bleeding
  • pallor
  • recurrent infections
  • hepatomegaly
  • lymphadenopathy
  • neurological findings
  • associated systemic immunological disorders
Full details

Risk factors

  • middle age
  • male sex
  • white ancestry
  • western hemisphere location
  • environmental exposures
  • genetic predisposition
  • Epstein-Barr virus
  • infectious mononucleosis
Full details

Diagnostic investigations

1st investigations to order

  • FBC with differential
  • peripheral blood smear
  • bone marrow trephine biopsy and aspiration (morphology assessment)
  • immunophenotyping (immunohistochemistry or flow cytometry)
  • comprehensive metabolic panel
  • serum lactate dehydrogenase (LDH)
  • viral serology for hepatitis B and C
Full details

Investigations to consider

  • molecular analysis (for BRAF V600E mutation or IGHV4-34 rearrangement)
  • CT chest, abdomen, and pelvis
Full details

Treatment algorithm

ACUTE

no indication(s) for treatment

indication(s) for treatment present: without splenic rupture or massive splenomegaly or marked thrombocytopenia precluding chemotherapy

indication(s) for treatment present: with massive symptomatic splenomegaly or splenic rupture or marked thrombocytopenia precluding chemotherapy

ONGOING

early relapse (<2 years) or refractory disease

late relapse (≥2 years)

Contributors

Authors

Ambuj Kumar, MD, MPH

Professor

USF Health Office of Research

Department of Internal Medicine, College of Medicine

Moffitt Cancer Center & Research Institute, Department of Health Outcomes & Behavior

University of South Florida

Tampa

FL

Disclosures

AK declares that he has no competing interests.

Mohamed A. Kharfan-Dabaja, MD, MBA, FACP

Professor

Division of Hematology-Oncology

Blood and Marrow Transplantation Program

Mayo Clinic

Jacksonville

FL

Declarações

MKD declares that he has no competing interests.

Agradecimentos

Dr Ambuj Kumar and Dr Mohamed Kharfan-Dabaja would like to gratefully acknowledge Dr Benjamin Djulbegovic, a previous contributor to this topic.

Declarações

BD declares that he has no competing interests.

Revisores

Daniel Catovsky, MD, FRCP, FRCPath, DSc, FMedSc

Consultant Haemato-Oncologist

Section of Haemato-Oncology

Brookes Lawley Institute of Cancer

Sutton

UK

Declarações

DC declares that he has no competing interests.

Roger Lyons, MD

Clinical Professor of Medicine

University of Texas Health Science Center San Antonio

San Antonio

TX

Declarações

RL declares that he has no competing interests.

Rebecca Connor, MD

Chief Fellow

Section of Hematology and Oncology

Department of Internal Medicine

Wake Forest University Baptist Medical Center

Winston-Salem

NC

Declarações

RC declares that she has no competing interests.

Claire Dearden, BSc, MD, FRCP, FRCPath

Consultant Haematologist

The Royal Marsden Hospital

Sutton

Surrey

UK

Declarações

CD declares that she has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

Parry-Jones N, Joshi A, Forconi F, et al. Guideline for diagnosis and management of hairy cell leukaemia (HCL) and hairy cell variant (HCL-V). Br J Haematol. 2020 Dec;191(5):730-7.Texto completo  Resumo

Troussard X, Maître E, Paillassa J. Hairy cell leukemia 2024: update on diagnosis, risk-stratification, and treatment - annual updates in hematological malignancies. Am J Hematol. 2024 Apr;99(4):679-96.Texto completo  Resumo

Grever MR, Abdel-Wahab O, Andritsos LA, et al. Consensus guidelines for the diagnosis and management of patients with classic hairy cell leukemia. Blood. 2017 Feb 2;129(5):553-60.Texto completo  Resumo

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: hairy cell leukemia [internet publication].Texto completo

Robak T, Matutes E, Catovsky D, et al. Hairy cell leukaemia: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015 Sep;26(suppl 5):v100-7.Texto completo  Resumo

Troussard X, Maître E, Cornet E. Hairy cell leukemia 2022: update on diagnosis, risk-stratification, and treatment. Am J Hematol. 2022 Feb 1;97(2):226-36.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Hairy cell leukaemia images
  • Diagnósticos diferenciais

    • Chronic lymphocytic leukaemia (CLL)
    • Mantle cell lymphoma
    • Pro-lymphocytic leukaemia
    Mais Diagnósticos diferenciais
  • Diretrizes

    • NCCN clinical practice guidelines in oncology: hairy cell leukemia
    • Guideline for diagnosis and management of hairy cell leukaemia (HCL) and hairy cell variant (HCL-V)
    Mais Diretrizes
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