Successful treatment of hairy cell leukemia with TP53 abnormality using cladribine combined with low-dose rituximab: a case report and literature review.
Zixin Chen, Lin Chen
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Case in brief
An elderly man with classical hairy cell leukemia (HCL) had BRAF V600E positivity, a TP53 deletion detected by fluorescence in situ hybridization, and bone marrow fibrosis. He received one cycle of cladribine with low-dose rituximab (100 mg), which was well tolerated. At 7-month follow-up, blood counts and marrow morphology had recovered; TP53 deletion was no longer detected by FISH, flow cytometry showed no minimal residual disease, and fibrosis had regressed from MF-2 to MF-0. The authors described this as complete molecular remission.
What made this case unusual
The response included disappearance of the detected TP53 deletion and reversal of bone marrow fibrosis, alongside negative minimal residual disease, after one cycle of cladribine with low-dose rituximab.
Diagnostic / clinical pearl
In this case, response assessment extended beyond blood counts to include marrow morphology, TP53 status by FISH, minimal residual disease by flow cytometry, and fibrosis grade.
Why it matters
The case suggests that cladribine combined with low-dose rituximab may achieve a deep response in classical HCL with TP53 abnormality; prospective studies are needed to validate this observation.