In those patients who fail to respond to either drug (Cladribine or Pentostatin), it is important to establish that the correct diagnosis was made.

Patients with the atypical variant of this disease do not respond as well to these standard agents. If the patient is non-responsive, splenectomy may be required. Alternatively, the patient could be referred to the National Institutes of Health (Dr. Kreitman at the National Cancer Institute) for experimental therapy. Some patients who failed on these other alternatives have responded to immune toxin conjugates.