毛状细胞白血病变异体(HCLv)是一种偶发性,B细胞非霍奇金淋巴瘤分类为慢性淋巴增殖性疾病。HCLv通常表现为容易疲劳,拖痛腹部,贫血,脾肿大,肝肿大,最初是白细胞增多,然后是白细胞减少症,涂片和骨髓中的毛细胞,和感染的风险增加。有高细胞骨髓,和血细胞减少继发于脾功能亢进。区分HCL与经典毛细胞白血病(HCLc)等疾病至关重要,脾边缘区淋巴瘤,和脾弥漫性红髓淋巴瘤,因为这些在生物学上是不同的,有不同的方法和结果。HCLv对标准嘌呤类似物克拉屈滨或喷他汀反应不良或主要难治。它甚至对克拉屈滨和利妥昔单抗组合的反应率较低,经典HCL的护理标准,应答率非常好。这里,我们介绍了一个老年男性,他表现为脾肿大和白细胞增多,诊断为HCLv,患者接受了基于克拉屈滨和利妥昔单抗的方案治疗,但在治疗后6个月时,流式细胞术显示骨髓中有残留细胞.流式细胞术检测外周血中无残留细胞。本文通过详细的文献分析讨论了该疾病的各个方面。在HCLv中研究更好的治疗方案以改善其总体结果的需求确实未满足。
Hairy cell leukemia variant (HCLv) is a sporadic, B-cell non-Hodgkin lymphoma classified under chronic lymphoproliferative disorders. HCLv usually presents with easy fatigue, dragging pain abdomen, anemia, splenomegaly, hepatomegaly, initially leukocytosis followed by leucopenia, hairy cells in the smear and bone marrow, and an increased risk of infections. There is hypercellular bone marrow, and cytopenias are secondary to hypersplenism. It is essential to differentiate HCL from disorders like classic hairy cell leukemia (HCLc), splenic marginal zone lymphoma, and splenic diffuse red pulp lymphoma, as these are biologically different, with divergent approaches and outcomes. HCLv is poorly responsive or primary refractory to standard purine analogs cladribine or pentostatin. It has lower response rates to even cladribine and rituximab combination, a standard of care for classic HCL with very good response rates. Here, we present a
case of an elderly male who presented with splenomegaly and leukocytosis, diagnosed as HCLv, and was treated with a cladribine and rituximab-based regime but showed residual cells in bone marrow on flow cytometry at six months post-treatment. There were no residual cells in peripheral blood in flow cytometry. Various aspects of the disease are discussed here with a detailed literature analysis. There is a definite unmet need for research on better treatment options in HCLv to improve its overall outcome.