Hairy cell leukemia-variant (HCL-V) is an extremely rare chronic B-cell lym
phoproliferative disorder clinically and morphologically distinct from clas
sic hairy cell leukemia (HCL), HCL-V is thought to represent a hybrid betwe
en prolymphocytic leukemia and HCL, the nucleus more closely resembling a p
rolymphocyte and the cytoplasm a hairy cell, The clinical course of HCL-V i
s aggressive with short survivals. Since single courses of cladribine have
profound activity in HCL, inducing durable complete responses in 91% of pat
ients, we administered cladribine to 4 patients with HCL-V over a 7-year pe
riod. During this time interval 357 patients with classic HCL received clad
ribine at Scripps Clinic. Each patient received cladribine at 0.1 mg/kg per
day by continuous intravenous infusion for 7 days, repeated at 28-day inte
rvals depending on response status. The 4 patients ranged in age from 28 to
70. Two presented with B-symptoms, 1 had peripheral adenopathy, and all 4
displayed massive splenomegaly. Peripheral blood counts were notable for ly
mphocytosis associated with mild anemia and thrombocytopenia, Only 1 of the
4 patients had received prior treatment. Peripheral blood immunophenotypic
analysis revealed monoclonal B cells with expression of CD11c in 3 patient
s, lack of CD25 expression in 3 patients and expression of CD103 in all but
1 patient. The number of cladribine courses administered ranged from two t
o five. Of these 4 patients, 1 (25%) achieved a complete response and 2 (50
%) partial responses, for an overall response rate of 75%. Three patients u
nderwent splenectomy after cladribine. Cladribine is an active agent in HCL
-V albeit with a lower response rate than in classic HCL, The role of other
treatment modalities, such as splenectomy, interferon-alpha, and 2'-deoxyc
oformycin, alone or in combination with cladribine awaits further evaluatio
n.