Top Reasons to Choose India for Hairy Cell Leukemia Treatment

Hairy Cell Leukemia

Hairy Cell Leukemia (HCL) is a slow growing, rare form of blood and bone marrow cancer. It influences the white blood cells (lymphocytes) of a person that serve an important purpose in combating infections.

What It Is?

• A form of B-cell leukemia (a form of non-Hodgkin lymphoma) that is chronic.
• It is named after the lobular shape of the abnormal lymphocytes when viewed through a microscope (they appear pecked with little tufts on their surface).
• It tends to be a slow progression and can take years before it has to be treated.

Hairy Cell Leukemia treatment in India

The treatment of Hairy Cell Leukemia (HCL) is as follows:

When to Start Treatment

All patients do not require urgent treatment. Treatment is recommended by doctors when there are:

• Anemia, neutropenia, or thrombocytopenia.
• Essential hypertrophy of the spleen with symptoms.
• Hebatitis C.
• Symptomatic disease (fatigue, abdominal fullness, weight loss, etc.).
• There are those patients who can also be observed months or years before the onset of therapy (watch and wait).

Initial-Line Therapy

Purine Analog Chemotherapy (Best Case Scenario)

Cladribine (2-CdA)

• As a single course (1-week continuous infusion or daily injections during 5 7 days).
• Gives remission in 80-90 percent of patients.
• Remission often lasts 10+ years.

Pentostatin

• Alternative to cladribine.
• Give IV twice a month in the case of remission.
• They are effective, long-lasting and well tolerated.

Biological Therapy

Interferon-alpha

• Increases immune system against leukemia cells.
• Administred to patients with intolerance to chemotherapy (e.g. during pregnancy, severe infections or kidney problems).
• Weak purine analogs, but useful nonetheless.

Relapsed / Resistant HCL Treatment

Approximately 30 to 40 percent of patients relapse following years of remission. Options include:

• Purine analogs- Retreatment is often effective again.

Monoclonal antibodies:

• Rituximab (antigen CD20 on leukemia cells).
• In mono- or combination therapy with purine analogs to achieve more profound remission.

Targeted Therapy BRAF mutation (V600E):

• Dabrafenib (or Vemurafenib) (oral) drugs.
• Particularly useful in relapses/refractory.

Immunotoxin therapy:

• Moxetumomab pasudotox (authorised in certain countries).
• Targets CD22 on leukemia cells.

Splenectomy (rare today):

• May be thought of in case of very troublesome spleen.

Hairy Cell Leukemia symptoms

The following are some of the symptoms of Hairy Cell Leukemia (HCL):

General Symptoms

These occur primarily due to decreased bone marrow and low blood counts:

• Weakness and fatigue (as a result of anemia)
• The prevalence of frequent or severe infections (because of low white blood cells, particularly neutropenia)
• Bleeding or easy bruising (platelets are low)

Abdominal Symptoms

Due to the presence of a large spleen (splenomegaly) - a characteristic of HCL:

• Abdominal fullness or pain in the left upper part of the abdomen.
• Early satiety (feeling full during the eating process)
• Pain in the abdomen (possibly due to swollen spleen)

Constitutional Symptoms

Less common, but may include:

• Low-grade fevers
• Night sweats
• Unexplained weight loss

Hairy Cell Leukemia diagnosis

The following is a well-organized and clear description of the diagnosis of Hairy Cell Leukemia (HCL):

Clinical Evaluation

• History/symptoms: Diffuse fatigue, infections, bruising, abdominal fullness (as a result of an enlarged spleen).
• Physical examination: Splenomegaly (quite frequent), hepatomegaly (occasionally), lymphadenopathy (rare).

Blood Tests

Complete Blood Count (CBC):

• Pancytopenia (low red blood, white blood, and platelet levels).
• It is monocytopenia (low monocytes).

Peripheral Blood Smear:

• Produces abnormal lymphocytes on whose surface there are hairy projections.

Bone Marrow Tests

Bone Marrow Aspiration/Biopsy:

• Usually has dry tap (due to fibrosis).
• In hairy cells, biopsy shows an infiltration of marrow.

Special Stains:

• TRAP (tartrate-resistant acid phosphatase) positivity (outdated marker, but no longer commonly used in modern immunophenotyping).

Immunophenotyping (Flow Cytometry)

Discovers cell surface markers that are unique:

• Positive for: CD11c, CD25, CD103, CD123
• Negative: CD5, CD10, CD23 (aids in distinguishing it as another leukemia/lymphoma).

Genetic / Molecular Tests

• BRAF V600E mutation (mutated in nearly all classic HCL).
• Obtains diagnosis and prescribes specific treatment.

Imaging

• Ultrasound/CT scan: Tested to assess the size of the spleen and liver, as well as to assess lymphadenopathy (generally not advanced in typical HCL).

Best treatment for Hairy Cell Leukemia

Treatment of Hairy Cell Leukemia (HCL) varies, depending on the type of the disease, the variant (HCL-v) or the classic type, the overall health of the patient, and the diagnosis or relapse.

First-Line (Initial) Treatment-Best Proven Treatments

Best chemotherapy: the gold standard is purine analog chemotherapy:

Cladribine (2-CdA) - most commonly used

• Given as a single course (as continuous IV infusion over 5-7 days or daily IV/SC injections over 5 days).
• Complete remission in 80-90 percent of patients.
• Remission often lasts 10+ years.

Pentostatin - useful substitute

• Give IV every 2 weeks until remission (several months).
• Like cladribine, similar long-term results.
• The two drugs are the best first-line drugs in classic HCL.

Relapsed / Resistant Disease

Should HCL recur (relapse) or fail to respond (refractory), choices would be:

• Cladribine or Pentostatin retreatment (which in most cases works again in case of relapse).
• Rituximab (anti-CD20 monoclonal antibody,) - given alone or combined with purine analogs to achieve greater remission.

Targeted Therapy (in BRAF V600E mutation patients):

• Vemurafenib/Dabrafenib (oral BRAF inhibitors).
• May be used together with Rituximab in order to achieve deeper remission.
• Moxetumomab pasudotox (immunotoxin, anti-CD22) - in multiply relapsed cases.

Supportive / Special Situations

• Interferon-alpha: When chemotherapy cannot be done (e.g. during pregnancy, active infection, kidney problems).
• Splenectomy: This is now rarely used but can be useful in the case of a massively enlarged spleen or when blood counts fail to respond to drugs.
• Antibiotics, antivirals, and transfusions, growth factors: Aids at treatment.

Best Treatment of HCL Variant (HCL-v) 

• Cladribine or pentostatin does not respond well to HCL-v.
• Rituximab, BRAF/MEK inhibitors (when mutation is present), or clinical trials would be the best options.

Hairy Cell Leukemia treatment in India with GetWellGo

GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.

We offer:

• Complete transparency
• Fair costs.
• 24 hour availability.
• Medical E-visas
• Online consultation from recognized Indian experts.
• Assistance in selecting India's top hospitals for Hairy Cell Leukemia treatment.
• Expert oncologists with a strong track record of success
• Assistance during and after the course of treatment.
• Language Support
• Travel and Accommodation Services
• Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
• Local SIM Cards
• Currency Exchange
• Arranging Patient’s local food