Hairy cell leukaemia and pregnancy: A systematic review and review of literature.

Hairy cell leukaemia (HCL) in pregnancy is exceptionally uncommon. A systematic review of the literature found 15 reported cases from 1960 to 2025. Eighty percent of cases were first diagnosed during pregnancy at a median maternal age of 32 years and a median gestational age of 14 weeks. Thrombocytopenia was universal and pancytopenia frequent. Forty-six percent of patients received therapy while pregnant, generally within 3 weeks of diagnosis. Interferon-alpha and splenectomy were the most common first-line options; pegylated interferon and rituximab were used less often. No maternal deaths, spontaneous abortions or stillbirths were reported. Median gestational age at delivery was 37 weeks, and 53.8% of births were vaginal. Post-partum therapy was administered in roughly half of the patients, most frequently cladribine, with favourable responses and preserved fertility in documented cases. Overall, current evidence supports carefully selected interferon-alpha, splenectomy or delayed systemic therapy as viable strategies that can control HCL without compromising obstetric outcomes, although individualized management and further evidence is needed.