Indications For Treatment

Hairy cell leukemia is an indolent lymphoproliferative disorder, which, prior to the advent of successful systemic therapy, had a median survival of 53 months. Approximately 10% of the patients diagnosed with this disorder never require therapy. This population is characterized by older age, smaller spleen size, and minimal circulating hairy cells.1 The following criteria, though not validated, are commonly accepted as appropriate indications for therapy: neutropenia characterized by an absolute neutrophil count (ANC) <1 X 109/L, anemia with a hemoglobin <10 g/dL, or thrombocytopenia < (50-100) X109/L, recurrent serious infections, or symptomatic splenomegaly. Much less commonly, bulky or painful lymphadenopathy, constitutional symptoms including fevers, chills, sweats, or weight loss, vasculitis, bone involvement, or leukocytosis with a high proportion of circulating hairy cells (white cell count >20 X 109/L) are also indications for treatment. Bone marrow involvement, no matter what the degree, is not an indication for therapy in the absence of peripheral blood cytopenias. The early initiation of therapy results in neither a survival nor a response benefit. Therefore, a strategy of careful observation is appropriate in patients who do not meet these criteria for the initiation of therapy.

0 0

Post a comment