Chemotherapy in hairy cell leukemia. Preliminary results of a nonaggressive regimen

Three patients with hairy cell leukemia, only one splenectomized, were treated with a combination of vinblastine plus bleomycin at low doses. One achieved a complete remission and another achieved a good partial hematologic and bone marrow remission. Neither of them has relapsed after follow-up periods of 34 and 17 months, respectively. The third patient, although achieving a hematologic improvement, died because of a cytomegalovirus pneumonitis after 2 cycles of chemotherapy. Chemotherapy is not usually employed in the initial management of hairy cell leukemia. However, if life-threatening neutropenia and thrombocytopenia occur secondary to severe bone marrow leukemia infiltration and an improvement does not take place using alternative therapeutic strategies, chemotherapy should be taken into consideration. The nonaggressive chemotherapeutic regimen the authors propose induces a cytoreduction without an evident myelosuppression, and can be also employed on an outpatient basis.