We identified three cases of hairy cell leukemia (HCL) in a small group of coal miners in Alabama, USA. All three cases of HCL were male, aged between 43 and 63 years old at diagnosis and had worked as miners between 6 and 14 years. All had long-term exposure to coal dust and diesel exhaust, which have been speculated as risk factors for HCL. We are highlighting the cluster to alert physicians about possible occupational causes of HCL. The miners' union contacted the Mine Safety and Health Administration (MSHA) because of concerns of high exposures to diesel fuel and exhaust. MSHA's Safety and Health Technology Center assessed the mine in July 2008 and found no elevated exhaust gas components (diesel particulate matter, carbon monoxide, nitric oxide and nitrogen dioxide). These findings likely do not reflect typical worker exposures because the mine was not producing at capacity at the time of the assessment. Nevertheless, MSHA recommended improved procedures for replacing diesel engine filters and maintaining filter housings. In August 2008, the National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation (HHE) at the coal mine. The union requesting the HHE was concerned about miners' exposure to coal dust and diesel fumes and exhaust, noting that the facility used diesel-powered equipment almost exclusively. The three cases all worked underground operating diesel-powered heavy machinery. HCL is a very rare hematopoietic malignancy, affecting fewer than 1000 persons annually in the United States. HCL represents 2 percent of adult leukemias, and affects males more than females in a ratio of 4:1. This suggests that the disease may be linked to occupational exposures. HCL follows an indolent course. Patients typically present with fatigue, and are found to have low blood cell counts and splenomegaly. Treatment with purine analogs (e.g. 2-cholorodeoxyadenosine, 2-CdA) has proven generally effective, with an overall response rate of 97 percent.
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