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A single course of cladribine or 2-chlorodeoxyadenosine 2-CDA , given as a continuous intravenous infusion over 7 days, induces a durable, complete response in most patients, with resolution of splenomegaly and cytopenias. Its name derives from the characteristic morphology of leukemic cells containing delicate, hairlike, circumferential cytoplasmic projections, best seen on bone marrow aspirate and peripheral blood smears. Clinically, there is a leukocytosis instead of a leukopenia and absence of an absolute monocytopenia. Cases that do not fit the classic morphologic and immunophenotypic profile of hairy cell leukemia may be better placed in an unclassified category of splenic small B-cell lymphoma with diffuse red pulp involvement until more is known about the pathogenetic differences underlying such neoplasms. Grossly, the spleen is massively enlarged median weight, g , and examination of the cut surface shows a beefy red pulp and absence of the normal pinpoint white pulp nodules Figure Unlike with other B-cell leukemic lymphomas, patients typically present with a leukopenic or sometimes a pancytopenic picture.
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