Expert consensus opinion on the management of hairy cell leukemia in elderly patients

The management of hairy cell leukemia (HCL) in elderly patients is becoming increasingly important as more patients are diagnosed at advanced ages (≥75 years) due to longer life expectancy. This expert consensus, based on a survey of international specialists from the Hairy Cell Leukemia Consortium, explores management strategies for this age group. Cladribine monotherapy remains the preferred first-line treatment, but its application varies, with dosage adjustments common to improve tolerability. Experts stress a holistic approach that considers advanced age, comorbidities, and individual patient circumstances. Although functional status and comorbidities are routinely assessed, structured frailty tools are rarely used. For relapsed cases, targeted therapies, including BRAF inhibitors with anti-CD20 antibodies, are favored. Challenges include managing comorbidities, infection risks, and a lack of geriatric-specific evidence. While current treatments are effective, the findings highlight the critical need for data exclusively derived from elderly HCL patients to develop tailored guidelines and improve outcomes in this vulnerable population.