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VH4\u201034 positive HCL cases are associated with a poor prognosis, as well as the rare cases of HCL with\n                      <jats:italic>TP53<\/jats:italic>\n                      mutations and HCL\u2010V.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Treatment<\/jats:title>\n                    <jats:p>Patients should be treated only if HCL is symptomatic. Chemotherapy with purine analogs (PNAs) are indicated in first\u2010line HCL patients. The use of chemo\u2010immunotherapy combining cladribine (CDA) and rituximab (R) represents an increasingly used therapeutic approach. Management of relapsed\/refractory disease is based on the use of BRAF inhibitors (BRAFi) plus R, MEK inhibitors (MEKi), Bruton Tyrosine Kinase inhibitors (BTKi) and\/or Bcl\u20102 inhibitors (Bcl\u20102i). The optimal sequence of the different treatments remains to be determined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ajh.70441","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:09:41Z","timestamp":1789456181000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hairy Cell Leukemia: 2026 Update on Diagnosis, Risk\u2010Stratification, and Treatment"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6863-9992","authenticated-orcid":false,"given":"Xavier","family":"Troussard","sequence":"first","affiliation":[{"name":"Laboratoire H\u00e9matologie CHU C\u00f4te de Nacre  Caen Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5967-8225","authenticated-orcid":false,"given":"Elsa","family":"Ma\u00eetre","sequence":"additional","affiliation":[{"name":"Laboratoire H\u00e9matologie CHU C\u00f4te de Nacre  Caen Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5280-018X","authenticated-orcid":false,"given":"J\u00e9r\u00f4me","family":"Paillassa","sequence":"additional","affiliation":[{"name":"Service des Maladies du Sang CHU Angers  Angers Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"e_1_2_19_2_1","unstructured":"M. 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