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Introduction. To compare the values and accuracy of the test in anticyclic citrullinated peptides antibodies, rheumatoid factor (RF), C-reactive protein (CRP) and disease activity index in early diagnosis of untreated psoriatic arthritis (PsA). Methods. Using the ELISA method of DIA-STATTM Anti CCP (Axis-Shield Diagnostics), sera of 70 participants were examined (35 untreated patients with PsA and 35 subjects from the healthy control group). RF and CRP were determined with the agglutination test (latex test). At the same time the sensitivity, specificity, predictive value for positive and negative testsand accuracy were determined. Results. Of 35 patientswith PsA, 1 patient showed presence of anti-CCP antibodies (sensitivity test 2.86%), while RF was foundin 0 patients(sensitivity test 0%). In the healthy control group positivevalues for RF, CRP and erythrocyte sedimentation rate were detected in 1 patient. Conclusion. ACPA antibodies have low sensitivity, but high specificity in PsA.

Introduction. To determine the effect of initial therapy with Paracetamol and Ketoprofen on glomerular and tubular integrity in rheumatoid arthritis (RA), to quantify nephrotoxicity of these two drugs by measurement of enzymuria, which correlates with the damage of tubular epithelium. Microalbuminuria is used as a marker for glomerular damage, and urine excretion of N-Acetyl-b-D-glucosaminidase (NAG) as an indicator of proximal tubular damage. Methods. Using colorimetric method for determination of NAG, and immunoturbidimetric method for microalbuminuria, samples of 70 participants were examined (35 RA patients treated with Paracetamol only, 35 RA patients treated with Ketoprofen). The follow-up was in 5 time-intervals in the course of 24 weeks. Results. There was a moderate correlation between NAG and microalbuminuria (r=0.16) in the group of patients treated with Paracetamol only, and a moderate correlation (r=0.28) in the group of patients treated with Ketoprofen. NAG enzymuria in size, by number of patients Registered, and time of appearance, was greater and appeared earlier in the Ketoprofen group compared to the Paracetamol group. Conclusions. Ketoprofen is more potent NAG inductor and provokes greater tubular enzymuria than Paracetamol. Results from our study confirm safety in use of Paracetamol and Ketoprofen in everyday clinical practice.

Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage “0” according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still with-out treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies.

Immune thrombocytopenia (ITP) is an autoimmune disease characterized by thrombocytopenia due to platelet autoantibodies, causing an accelerated clearance of opsonized platelets by phagocytes. The etiology of ITP remains unclear, both genetic and environmental factors may have a role in the disease development. The aim of our study was to investigate a possible association of three single nucleotide polymorphisms (SNP) in the genes for interleukin beta (IL1B-511C/T), tumor necrosis factor beta (TNF+252G/A) and tumor necrosis factor alpha (TNFA-308G/A) with ITP. We have analyzed 125 adult patients with ITP and 120 healthy matched controls. Genotyping was performed by using PCR- RFLP methods. Our results demonstrated significantly different genotype distributions and allele frequencies for TNFB+252G/A in patients with ITP, p = 0.005 and p = 0.009 with Yates correction. We did not find any significant differences in the genotype distribution or allele frequencies for the other two genes. We have found significantly different genotype distribution and allele frequencies for TNFA- 308G/A between patients with unresponsive and responsive ITP patients, p = 0.016 and p = 0.009. There were no significant differences in genotype distribution and allele frequencies for ILB-511C/T and TNFB+252G/A polymorphisms between those two groups of patients. We did not find any significant differences in genotype distribution and allele frequencies for all three polymorphisms between splenectomized and unsplenectomized ITP patients. The obtained data indicate that the A allele of TNFB+252G/A is more frequent in these patients than in the controls and that this polymorphism may play a significant role in disease susceptibility. The A allele of TNFA-308G/A was more frequent in patients with unresponsive ITP, indicating that this gene polymorphisms may contribute to therapy resistance.

Background: Accurate prediction of a patient’s prognosis is useful to define the risk posed by the disease. Age, gender, peripheral blood cyto penia, proportion of bone marrow (BM) blasts, performance status, comorbidities, transfusion dependence, specific karyotype abnormalities and molecular biomarkers can refine the prediction of prognosis in MDS. Aim: to assess the influence of the some prognostic factors like age, gender, cytopenia, BM blast percentage, transfusion dependence, ferritin, hemoglobin (Hb), lactate dehydrogenase (LDH), albumin and specific karyotype abnormalities in myelodysplastic syndromes on overall survival (OS). Patients and methods: we retrospectively analyzed the cohort of 108 patients diagnosed between 1.1.2011 and 31.12.2013 at the University Clinic of Hematology, Ss Cyril and Methodius University, Skopje, Macedonia. They were evaluated for clinical and hematologic features at diagnosis and at leukemic transformation. Results: in the study group 62 were man and 46 women. Male to female ratio was 1.35 to 1. The differences in OS between men and women were significant (p = .03015). The mean age at diagnosis was 66,6 years. According to the age OS was 16,4 months. FAB subtypes influenced OS significantly (p = .03015). OS inversely correlated with BM blast percentage (p= .02327). Cytopenia had no impact on OS (p=.33755). Hb as a whole and groups with different levels of Hb had no influence on OS (p = .12142) and (p= .07535), respectively. The group with ferritin

Background: Bone lytic lesion in Multiple myeloma are the most commonly presented symptoms which require treatment with bisphosphonates (BPs). BPs are providing supportive care, reducing the rate of skeletal morbidity but evidently not abolishing it, the criteria for stopping their administration have to be different from those used for classic antineoplastic drugs, and they should not be stopped when metastatic bone disease is progressing. Osteonecrosis of the jaw (ONJ) has been associated recently with the use of BPs. Aim: The aim of these study is to evaluate the incidence of ONJ in patients with MM treated with mixed biphosphonates. Patients and methods: We analyzed total 296 myeloma patients (150 male and 146 female). Mostly effected age group with 58,1% is age more than 60 years up to 88 years, diagnosed in our institution in the period 2005-2015. We used intravenous or oral forms of biphosphonates such as pamidronate, ibandronate, clodronate and zolendronic acid. The patients were evaluated for ONJ. Results: The incidence of ONJ in our group of patients treated with Bps was 4,6% from our group of 260 patients 87,8% received BPs therapy and patients which haven’t received BPs 12,2%. From this group, 95,4% (248) didn’t show ONJ, and 4,6% (12) showed ONJ. The period of this treatment with BPs is an important risk factor for development of ONJ, average duration of BPs therapy in patients which show adverse effects is 26.8±13.7 months, from the total number of 12 patients that developed ONJ adverse effects, we have 8 patients which received treatment with Zolendronic acid and the remaining 4 patients which were treated with other BPs combinations without Zolendronic acid. Conclusions: All patients treated for MM must continue with the therapy with Zolendronic acid and Pamidronate, each patient must be individually treated according to his response of the treatment (dose, frequency and duration of therapy).

Association Between Osteoarticular Scores and Acute Phase Reactant Levels in Rheumatoid Arthritis The aim of this prospective control study was a quantitative evaluation of the activity of rheumatoid arthritis (RA) in certain time intervals, using articular indexes (set of 28 sensitive and 28 swollen joints), laboratory parameters (Hb, Hct, Er, Le and Plt) and acute phase reactants (ESR, RF, CRP); to determine which of the acute phase reactants is the most useful biochemical marker for the evaluation of disease activity in RA; to quantify the therapeutical and laboratory differences in certain time intervals in the group with and without immunomodulatory therapy with Methotrexate. Sixty patients with RA were included, 27 of who were treated with non-steroid antiinflammatory drugs (NSAIDs) and Methotrexate (MTX). The control group consisted of 33 patients treated only with NSAIDs because of irregular controls. In the first group of patients the disease activity was estimated at four time intervals, and in the control group of patients at three time intervals following the scores of the articular indexes, blood cell counts, ESR and CRP in every patient. In the first group of patients decreased activity of RA was found upon every following control with a consecutive decrease in mean values of the scores of articular indexes with statistically significant differences at the four time intervals. Considering laboratory parameters, there were statistically significant differences in the mean values of Hb, Er, Plt, ESR, (p=0.0462, p=0.0076, p= 0.0058, p= 0.0003). Mean values of CRP did not show statistically significant differences, but the number of patients who were CRP negative increased (there were great standard deviations). In the group of patients treated only with NSAIDs, there were statistically significant differences in the mean values of the scores of articular indexes with an increse at every following control (in favour of progression of the disease). There were no statistically significant differences considering blood cell counts, ESR and CRP (in favour of permanently active disease). In conclusion, CRP is the most useful marker for the prospective follow-up of patients with RA.

Association Between Sharp's Radiographic Index and Acute Phase Reactants in Rheumatoid ArthritisThe aim of this study was to evaluate the activity of rheumatoid arthritis (RA) by hand radiography (Sharp's radiographic index), and assessment of acute phase reactants - erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and rheumatoid factor (RF), and to determine their value as prognostic markers for disease outcome in patients with early RA treated with disease modifying antirheumatic drugs (DMARDs)-Methotrexate (MTH); to register and quantify clinical, radiographic and laboratorial differences in certain time intervals in a group of patients treated with immunomodulation therapy with MTH; to determine which of the acute phase reactants would be the most useful marker for evaluation of disease activity in long-term follow-up in RA patients; to select high-risk groups with aggressive course of disease, in order to emphasize the necessity of early and aggressive treatment. Thirty patients with early RA (disease evolution up to 1 year) were evaluated in several time intervals. The score of the Sharp's index showed greater radiographic progression of the joint damage of hands in time intervals between 0-time and 12 months (p=0.0167) and between 0-time and 18 months (p=0.0089). Statistical analysis showed differences in values of CRP in four time intervals (p=0.00002). Considering CRP, there were statistically significant differences among mean values in four time intervals (p=0.0428) (standard deviations showed greater variations). There were no statistically significant differences among mean values of RF in four time intervals (p=0.573). At 0-time in 3 (10%) patients progression of the Sharp's index was found, after 6 months in 13 (39%) patients, while after 12 and 18 months progression of the Sharp's index was found in an identical number of patients, 15 (50%). In most patients high values of CRP and RF were found. Progression of the radiographic damage is especially expressed in patients with high values of ESR, CRP, RF and existence of previous erosions of hands, which are predictors for aggressive course of disease. CRP is the most useful marker for the evaluation of RA activity in the long-term followup of RA patients.

The Diagnostic Value of N-Acetyl-β-D-Glucosaminidase and Microalbumin Concentrations in Rheumatoid ArthritisThe purpose of this research was to compare the diagnostic values of laboratory variables, to present quantitative evaluations of the diagnostic sifted test with reference to sensitivity and specificity, the predictive value of the positive and negative test and precision of the test for N-acetyl-β-D-glucosa-minidase (NAG), microalbumin, rheumatoid factor (RF), Creactive protein (CRP), DAS 28 index, in early diagnosis of untreated rheumatoid arthritis (RA), and to define the effect of untreated rheumatoid arthritis on glomerular and tubular function. Using a colorimetric assay for the determination of Nacetyl-β-D-glucosaminidase and an immunoturbidimetric assay for the determination of urinary albumin, the samples of serum and urine have been examined in 70 participants (35 RA who were not treated, 35 healthy controls). RF was defined with the test for agglutination (Latex RF test) in the same participants. Out of 35 examined patients with RA, in 13 we found the presence of NAG enzymuria (sensitivity of the test 37.14%), while microalbuminuria appeared in 4 patients (sensitivity of the test 11.42%). RF appeared in 17 patients (sensitivity of the test 48.57%). Four patients were NAG and RF positive, while 3 patients were microalbuminuria and RF positive. Among 18 RF negative patients, 9 patients were NAG positive, and 1 patient presented with microalbuminuria. Among 17 RF positive RA, the presence of NAG was found in 4 patients, and the presence of microalbuminuria in 3 patients. Among 18 RF negative RA, NAG enzymuria appeared in 9 patients. Microalbuminuria was present in 1 patient. In the healthy control group, 8 patients were NAG positive, 2 patients were positive for microalbuminuria. RF appeared in 2 patients. NAG has higher sensitivity than microalbuminuria in the detection of asymptomatic renal lesions in untreated RA.

Introduction: When establishing new diagnostic method for detection of the endothelial dysfunction in Rheumathoid Arthritis (RA), it is necessary to compare the diagnostic values with other laboratory variables. Aim: To Assess Asymmetric Dimethylarginine (ADMA) in RA and study its relation to ACPA and different clinical and laboratory parameters of disease activity in early non treated RA patients. Also, to determine the association between the asymmetric dimethylarginine (ADMA) and anti-cyclic citrullinated peptide antibodies (ACPA, Anti-CCP 2 ) of the second generation in RA and to explain their connection in the process of citrulination of autoantigens in RA. Also, to determine the association between ADMA and the acute phase reactants: Rheumatoid factor (RF), C-reactive protein (CRP), as well as the index of disease intensity (DAS 28 ) in early diagnosis in non-treated RA patients and to determine whether the amount of ADMA changes in the course of the evolution of disease. Methods: Using the ELISA method (DLD-Diagnostika-GMBH for ADMA and BioSystems S.A. Reagens & Instruments Costa Brava 30, Barselona, Spain), the sera of 70 subjects have been examined (35 RA not-treated, 35 healthy control group). Results: Of 35 patients with RA, presence of ADMA was detected in 13 patients (37.14%); RF was present in 17 patients (48.57%), while anti-CCP2 antibodies were present in 23 patients (65.71%). Of 18 patients who were RF negative, ADMA was detected in 9 patients (50%), while 11 patients (31.43%) were anti-CCP2 positive. In 17 RF positive patients with RA, ADMA was detected in 4 patients, while 12 patients (34.28%) were anti-CCP2 and RF positive. In the healthy control group 8 patients (22.85%) showed ADMA positivity. There was moderate correlation between ADMA and anti-CCP2 antibodies in the group of patients with RA (r=0.34). Conclusion: There was an association between ADMA and anti- CCP 2 antibodies of the second generation in patients with RA.

Aim: The aim of this study was to compare the diagnostic values of laboratory variables, to present quantitative evaluations of the anti citrullinated protein / peptide antibody (ACPA), or anti CCP ( anti-cyclic citrullinated peptide, anti-CCP 2) antibodies in second generation antibody assay diagnostic test with reference to sensitivity and specificity, the predictive value of the positive and negative test and precision of the test for ACPA antibodies, rheumatoid factor, C-reactive protein and DAS 28 index, in the early diagnosis of untreated rheumatoid arthritis. Materials and methods: 70 participants (35 patients with rheumatoid arthritis not treated, 35 individuals as healthy controls) took part in the study. Their serum was examined using ELISA technology of DIA-STAT TM Anti-CCP (Axis–Shield Diagnostics). Rheumatoid factor was examined with the test for agglutination (Latex RF test). Results: We found the presence of ACPA antibodies (sensitivity of the test 65.71%) in 23 of the 35 examined patients with rheumatoid arthritis while rheumatoid factor appeared in 17 patients (sensitivity of the test 48.57%). Twelve patients were ACPA and rheumatoid factor positive, 11 were ACPA positive, but rheumatoid factor negative. Five patients were ACPA negative and rheumatoid factor positive. In 17 rheumatoid factor positive patients, ACPA antibodies were positive in 12 patients. Of 18 rheumatoid factor negative patients, 11 were ACPA positive. In the healthy control group, 1 patient was anti-CCP 2 positive, while 2 patients were rheumatoid factor positive. Conclusion: ACPA antibodies have higher sensitivity and specificity than rheumatoid factor in rheumatoid arthritis.

Introduction: Myeloma multiplex is defined by the presence of monoclonal plasma cell population in the bone marrow>10%,M protein in the serum and/or urine ,and clinical evidence of end organ damage like hypercalcemia ,renal failure, anemia, or bone lesions. In the most hematologic malignancies the role of induction treatment is to achieve complete remission (CR). Thalidomide became a new therapeutic approach but use of Thalidomide as a single agent or combination with steroids or chemotherapy is associated with several side effects like deep vein thrombosis (DVT), peripheral neuropathy (PN), constipation, somnolence, pyrexia, pain, fatigue osteonecrosis of jaw, and teratogenicity that is the most worrying adverse event. Risk of appearance of DVT increased if we use combination of Thalidomide plus Dexamethasone plus cytotoxic chemotherapy such Cyclophosphamide. >30% DVT usually occurs during the first months of treatment and is more frequent in newly diagnosed patients with a high tumor burden. The second side effect is peripheral neuropathy (PN) which occurs in 50% of patients with MM treated with Thalidomide plus Dexamethasone and chemotherapy. Patients and methods: Eighty patients of both sexes (43 males and 37 females) at the age of 31-81 (median range 58 years) with MM, were treated–one group with combinations of Thalidomide plus Dexamethasone plus Cyclophosphamide (CyThalDex) 4 cycle(>4months), and the other group with Thalidomide plus Dexamethasone plus Melphalan (MPT), (>4month) and third group with high dose of chemotherapy and continue with ThalDex (TD), the fourth group with CyThalDex, > than 5 cycles, and the fifth group with ThalDex (TD) only. Results: It is obvious while myelo-suppression is very rare, the incidence of nonhematologic side effects is high and dose dependent. Eight (or 10%) patients that developed DVT and CVI were initially treated with antiaggregation therapy of Aspirin 100mg per day, but those that already developed were treated with low dose of Heparin 40000 iE per day in ten days and continued with oral anticoagulans therapy. However, besides the given therapy in four (or 5 %) patients there was exitus letalis. PN was developed in twentyone patients (or 26.25%) from the total number of patients treated with Thalidomide, in ten patients the dosage of Thalidomide was decreased to 50mg per day, in one patient with Epi attacks it was interrupted and the other was with paresis n.occulomotorius and n.abducens. Conclusions: Patients treated with thalidomide have an increased risk of arterial thromboembolism, including myocardial infarction and cerebrovascular events, in addition to the established risk of venous thromboembolism, but most patients who presenting DVT or some of thromboembolic events have had identifiable risk factors. The prolonged exposure to Thalidomide seems to induce resistance of MM reducing overall survival (OS). We must evaluate consolidation and maintenance therapies with Thalidomide, determinate which regimens provide a highness benefit with favorable side effect profiles in specific subgroups of patients.

Aim: The aim of this study was to detect and compare the enzymes, globulins and reactants of the early phase in patients with untreated rheumatoid arthritis and to reveal the effect of untreated rheumatoid arthritis on tubular function and sensitivity on brush border area. Material and Methods: The samples of serum and urine were examined in 70 participants (35 patients with untreated rheumatoid arthritis, 35 individuals of the healthy control group). We used in the study the kinetic assay for determination of alanine aminopeptidase (AAP) (Standards methods under IFCC), γ-glutamiytransferase and MEIA (Microparticle Enzyme Immunoassay) (Abbot Axsym system) for detection of β 2-microglobulin in urine. Results: Of 35 patients with RA, 16 patients showed presence of γ-GT (sensitivity of the test - 45.71%), 24 patients showed presence of AAP enzymuria (sensitivity of the test - 68.57%), while the presence of β2-microglobulin in urine was very low (sensitivity of the test - 0%). From 18 RF negative patients, 14 patients were AAP positive, 10 patients were γ-GT positive, while the presence of β2-microglobulin in urine was not detected. Among 17 RF positive patients with RA, the presence of AAP was detected in 10 patients, the presence of γ-GT in 6 patients, while the presence of β2-microglobulin in urine was not detected. Conclusion: In untreated rheumatoid arthritis AAP had higher sensitivity than γ-GT and β2-microglobulin in detection of asymptomatic renal damage

Immune thrombocytopenia (ITP) is an autoimmune disease of unknown etiology, characterized by isolated thrombocytopenia and the absence of any underlying cause for thrombocytopenia. Corticosteroids are the standard first line treatment for patients with symptomatic disease, inducing platelet count recovery in 70-80% of patients; but in many cases, steroid tapering or withdrawal is followed by a decrease of platelet count and the need for additional treatment. Splenectomy is still the standard salvage therapy in cases refractory to corticosteroid therapy. In the past decade monoclonal anti-CD20 antibodies (Rituximab) are being increasingly used in patients with refractory ITP and other autoimmune diseases. Recent studies show that Rituximab is useful in the treatment of patients with chronic and refractory ITP. We report two cases with chronic ITP treated with standard dose of Rituximab in four weekly doses and than continue to receive maintenance therapy with Rituximab for 2 years.

Proximal tubules of the kidney have a dominant function in the excretion of different enzymes in the urine. These enzymes can be used as markers for secondary renal damage under the action of different diseases, medicines, and toxins. The aim of this study was to evaluate the values of alanine aminopeptidase (AAP), gamma-glutamyl transferase (gamma-GT), and beta2 microglobulin (beta2m) in urine of patients with untreated rheumatoid arthritis (RA) and to define the possible association between untreated rheumatoid arthritis and tubular function at the brush border region.We used a kinetic assay for AAP, standard methods by the International Federation for Clinical Chemistry (IFCC) for gamma-GT and Microparticle Enzyme Immunoassay (MEIA), (Abbott A(x)SYM System) for the determination of beta2m in urine of 70 participants (35 untreated RA patients and 35 healthy volunteers (HC)).From the total of 35 RA patients, AAP enzymuria was found in 24 patients with test sensitivity (68.57%), gamma-GT in 16 patients with test sensitivity (45.71%), while the presence of urinary beta2m was found in a very low percentage of cases. Out of 18 rheumatoid factor (RF) negative patients, 14 patients were AAP and 10 patients were gamma-GT positive, while the presence of beta2m in urine was not detected. Among 17 RF positive RA patients, the presence of AAP and gamma-GT was noticed in 10 and 6 patients, respectively, while the presence of beta2m in urine was not detected.In conclusion, AAP had a higher sensitivity than gamma-GT and beta2m in detection of asymptomatic renal lesions in untreated RA.

Multiple myeloma is still an incurable disease with pattern of regression and remission followed by multiple relapses raising from the residual myeloma cells surviving even in the patients who achieve complete clinical response to treatment. In recent years there is a huge improvement in treatment of patients with multiple myeloma. The milestones of these improvement are: autologous transplantation and high-dose melphalan, imunomodulating drugs (thalidomide, lenalidomide), proteosom inhibitors (bortesomib, carfilzomib). The most significant improvement in overall survival has been achieved in the patients younger than 65 years. So, the major challenge for hematologist is to translate this improvement in the elderly patients with multiple myeloma. Today, physicians are able to offer wider variety of treatment options for elderly patients with multiple myeloma. Therapeutic options should be tailored and personalized according to patient's characteristics by balancing efficacy and toxicity of each drug which is especially important for elderly patients. In the mode of sequencing treatment for elderly patients with multiple myeloma, our goal is to achieve and maintain maximal response while limiting treatment -related toxicities as much as possible. Second-generation novel agent, such as carfilzomib, pomalidomide, elotuzumab, bendamustine are currently being evaluated as an option to improve treatment outcome in elderly patients.

Hairy cell leukemia (HCL) is a very rare type of leukemia, in which abnormal B lymphocytes, present in the bone marrow, spleen, and peripheral blood stream, get worse slowly or do not get worse at all. HCL is the disease where patients have pancytopenia with splenomegalia over 90% percent, palpable lymphadenopathy occur in 35% of patients, some form of serious infection eventually developed in over 50% of patients and was the most common cause of death in patients. HCL is dominantly a male disease, with the male-female ratio, ranging from 4:1 to 7:1. Treatment and prognosis of HCL depends on: the number of HC in the peripheral blood or bone marrow, if the spleen is enlarged and on the existence of the visible leukemia infection symptoms. Prognostic factors are similar to the above mentioned and also if the basic disease HCL is aggressive or the number of HC grow slowly and there is no need for treatment. Starting from September 1985 till September 2010, we observed a group with total number of 28 patients (22 males and 6 females) at the age of 30-76 (median range 46 years), all with HCL disease. From the total number of participants, 20 patients (71,43%) received hemotherapy, Cladribine and 8 patients (28,57%) received different type of therapy, such as immunomodulator therapy, surgery or combination of both, without Cladribine. Most effective therapy for HCL, from all of the above mentioned was definitely Cladribine which is dominant with a resulting response rates of 80-100%, where 70-90% of patients were achieving a complete remission, as defined by a complete disappearance of hairy cells in the bone marrow.