Refining prognostic factors in chronic lymphocytic leukemia.

Abstract

Recent knowledge in the understanding of biology and natural history of chronic lymphocytic leukemia (CLL), along with the emerging of new and more effective treatments have changed the way the CLL patients are studied and treated. Most of the patients are now being diagnosed in early stages and at much younger age than previously, resulting in longer overall survival but also posing special problems in respect to their clinical management. Moreover, in individual patients the prognosis is extremely variable, ranging from a very short to a normal lifespan. Thus, as a requisite for an optimal choice of therapy, prognostic assessment should be as precise as possible. Classic clinical stages, based on easily obtainable biologic and clinical parameters, have been the most important factor for assessing prognosis in CLL patients. However, although easy to apply, they are not devoid of limitations. For these reasons, recent investigations are searching new parameters in an attempt to add prognostic power to clinical stages. The prognostic impact of these new parameters, usually based on important biologic discoveries, is under investigation in prospective trials. Meanwhile, the classic prognostic factors ‐ particularly clinical stages ‐ should continue to be the basis for assessing prognosis, as well as forming the benchmark against which new prognostic parameters should be measured.