Sandbox: HCL therapy: Difference between revisions

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==Overview==
<br>
==Medical Therapy==
{{familytree/start |summary=PE diagnosis Algorithm.}}
* Indications to initiate medical therapy among patients with hairy cell leukemia include:
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:* The presence of systemic symptoms such as fever, night sweats, and significant weight loss
{{familytree|boxstyle= border-top: 0px;| | | | | | A01 | | | | | | |A01=<div style="width: 15em; padding:1em;text-align:center">History<br>Physical examination<br>Complete blood count</div>}}
:* The presence of subcostal abdominal discomfort due splenic distension
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:* Positive history of recurrent infections.
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:* Hemoglobin concentration lower than 12 g/dl
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:* Platelets count lower than 100,000/mcl
{{familytree | | | | B02 | |B01| | |B02=<div style="width: 10em; padding:1em;text-align:center">'''Asymptomatic patients with no therapeutic indications'''</div>|B01=<div style="width: 15em; padding:1em;text-align:center">'''Symptomatic patients or evidence of therapeutic indications '''</div>}}
:* Absolute neutrophil count lower than 1000/mcl
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* Pharmacological agents used for the treatment of hairy cell leukemia patients include:
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:* [[Cladribine]]  
'''[[Cladribine]]'''<br>
:* [[Pentostatin]]
'''[[Pentostatin]]'''</div>|C02=<div style="width: 15em; padding:1em;text-align:center">'''Patients managed by observation and close follow-up'''</div>}}
:* [[Rituximab]]  
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:* [[Interferon alpha]]
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:* [[Vemurafenib]]
{{familytree | | | | | | D02 | | D01 | | | | | | | | | |D01=<div style="width: 15em; padding:1em;text-align:center">'''No evidence of complete response'''</div>|D02=<div style="width: 15em; padding:1em;text-align:center">'''Complete response'''</div>}}
 
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Patients presenting with thrombocytopenia or anemia due to bone marrow failure
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Patients presenting with refractory autoimmune hemolytic anemia or refractory autoimmune thrombocytopenia
'''[[Retuximab]] alone'''<br>
Evidence of symptomatic splenomegaly, with the spleen being palpated more than 6cm below the costal margin
'''[[Interferon alpha]] alone'''<br>
Evidence of symptomatic progressive lymph nodes swelling, with a size greater than 10 cm in diameter
'''Alternative purine analogue {{withorwithout}} rituximab'''</div>|E02=<div style="width: 13em; padding:1em;text-align:center">'''Follow-up and close observation'''</div>}}
Evidence of a rapidly progressive lymphocytosis, which might be observed as:
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An increase of greater than 50% over a 2-month period
{{familytree | | | | | | E02 | | E01 | | | | | | | | | | |E01=<div style="width: 17em; padding:1em;text-align:center">'''No evidence of complete response'''</div>|E02=<div style="width: 13em; padding:1em;">
A lymphocyte doubling period shorter than six months
'''Relapse after one year: same initial purine analogue ± rituximab'''<br>
'''Relapse before one year: alternative purine analogue ± rituximab'''</div>}}
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{{familytree | | | | | | | | | | |!| | | | | | | | | | | }}
{{familytree | | | | | | | | | | E01 | | | | | | | | | | |E01=<div style="width: 17em; padding:1em;text-align:lef">'''[[Vemurafenib]]'''</div>}}
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<br>

Latest revision as of 02:16, 30 October 2015


 
 
 
 
 
Initial patients evaluation
 
 
 
 
 
 
 
 
 
 
History
Physical examination
Complete blood count
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Asymptomatic patients with no therapeutic indications
 
Symptomatic patients or evidence of therapeutic indications
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Patients managed by observation and close follow-up
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Complete response
 
No evidence of complete response
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Follow-up and close observation
 

Retuximab alone
Interferon alpha alone

Alternative purine analogue ± rituximab
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Relapse after one year: same initial purine analogue ± rituximab

Relapse before one year: alternative purine analogue ± rituximab
 
No evidence of complete response
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


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