Haematology: hairy cell leukaemia: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

Try it

General Medicine · Haematology: hairy cell leukaemia

Sample item

A 55-year-old man has fatigue, recurrent infections, a palpable spleen 8 cm below the costal margin and no lymphadenopathy. Counts show pancytopenia with monocytopenia, and bone marrow aspiration gives a dry tap. Flow cytometry shows CD11c, CD25 and CD103 positive B cells with a BRAF V600E mutation. What is the treatment of choice?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Cladribine

Hairy cell leukaemia is an indolent B-cell neoplasm with splenomegaly, pancytopenia, a dry tap from marrow fibrosis, and cells that are tartrate-resistant acid phosphatase positive with a BRAF V600E mutation. A single course of cladribine, a purine analogue, induces long remissions in most patients. Splenectomy and interferon are historical options.

Option by option

  • A. Cladribine (correct)

    Correct. A purine analogue achieves high complete response rates in hairy cell leukaemia.

  • B. All-trans retinoic acid with arsenic trioxide

    ATRA with arsenic trioxide treats acute promyelocytic leukaemia with t(15;17).

  • C. Cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) every 3 weeks

    CHOP is used for aggressive lymphomas and is not standard for this indolent leukaemia.

  • D. Imatinib

    Imatinib inhibits BCR-ABL in chronic myeloid leukaemia and has no activity here.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is A, Cladribine. Hairy cell leukaemia is an indolent B-cell neoplasm with splenomegaly, pancytopenia, a dry tap from marrow fibrosis, and cells that are tartrate-resistant acid phosphatase positive with a BRAF V600E mutation.

Why is "All-trans retinoic acid with arsenic trioxide" not the answer?

ATRA with arsenic trioxide treats acute promyelocytic leukaemia with t(15;17).

Why is "Cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) ev…" not the answer?

CHOP is used for aggressive lymphomas and is not standard for this indolent leukaemia.

Why is "Imatinib" not the answer?

Imatinib inhibits BCR-ABL in chronic myeloid leukaemia and has no activity here.

What concept does this question test?

It tests Haematology: hairy cell leukaemia in General Medicine. A single course of cladribine, a purine analogue, induces long remissions in most patients. Splenectomy and interferon are historical options.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Haematology: hairy cell leukaemia?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.