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Hairy Cell Leukemia

Leslie A. Andritsos, MD

Associate Professor of Medicine, Division of Hematology, Department of Internal Medicine, The Ohio State University, Wexner Medical Center, James Cancer Center and Solove Research Institute, Columbus, OH

Mirela Anghelina, MD

Non-Therapeutic Clinical Trials, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH

Kelly E. Johnson, PhD

Non-Therapeutic Clinical Trials, Division of Hematology, The Ohio State University Comprehensive Cancer Center, Columbus, OH

Question 6

A 72-year old man with no significant past medical history presents for evaluation of fatigue. On physical exam he appears pale and has palpable cervical lymphadenopathy as well as splenomegaly. Laboratory testing reveals a white blood cell (WBC) count of 35,000/µL with a hemoglobin level of 5.6 g/dL and a platelet count of 86 x 103/µL. Review of the peripheral blood smear shows a predominance of WBCs with pale blue cytoplasm, prominent nucleoli, and serrated hair-like projections.

Which of the following is the most appropriate next step in the management of this patient?

  •   Inform him that he has hairy cell leukemia (HCL)
  •   Initiate therapy with cladribine
  •   Perform a bone marrow aspiration and biopsy
  •   Refer him to a tertiary medical center

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