Progress Report on Chiorambucil Therapy in Postsplenectomy Patients With Progressive Hairy Cell Leukemia

H AIRY CELL leukemia, a disease characterized by splenomegaly without adenopathy, by pancytopenia, and by circulating malignant cells with prominent cytoplasmic projections requires therapy in most cases.”2 The manifestations of hairy cell leukemia result from a balance between (I) leukemic infiltration of the red pulp of the spleen by hairy cells, which leads to hypersplenism,3 and (2) leukemic infiltration of the bone marrow, which leads to decreased production of bone marrow elements and to peripheral blood cytopenia(s). In most cases, the hypersplenism can be corrected by splenectomy;4 however, approximately one-third of the patients have progressive disease in the bone marrow, which manifests itself either by a leukemic phase with various associated cytopenias or by progressive pancytopenia. In four earlier patients, we originally suggested treatment with chlorambucil for these manifestations of progressive disease.5 Five additional patients have subsequently been treated with chlorambucil. All of these nine patients are the subjects of this report.