Use of Prognostic Indicators at Diagnosis in CLL

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Use of prognostic factors in risk stratification at diagnosis and

time of treatment of patients with chronic lymphocytic leukemia.

Lymphoid biology and diseases

Current Opinion in Hematology. 13(4):266-272, July 2006.

Gowda, Aruna a; Byrd, C a,b

Abstract:

Purpose of review: To review risk stratification strategies used in

chronic lymphocytic leukemia at diagnosis to predict aggressiveness

of disease and, at time of treatment, to predict duration of response.

Recent findings: Several new prognostic factors can better assist

clinicians in predicting the aggressiveness of chronic lymphocytic

leukemia at diagnosis and the likelihood of maintaining a prolonged

remission with treatment.

This article reviews older prognostic factors such as [beta]2-

microglobulin and thymidine kinase activity that have been partially

validated by recently completed large studies. New prognostic factors

such as interphase cytogenetics, immunoglobulin heavy-chain gene

mutational analysis, and relevant secondary surrogate markers of

immunoglobulin heavy-chain gene, including methylation of the zeta-

associated protein gene, lipoprotein lipase overexpression, telomere

length, and telomerase activity are reviewed.

Some prognostic factors (interphase cytogenetics) but not others

(immunoglobulin heavy-chain gene mutational status, zeta-associated

protein expression) predict the duration of response to fludarabine-

based combination strategies.

Summary: Recent advances in risk stratification provide clinicians

with tools to better predict outcome of chronic lymphocytic leukemia

at the time of treatment and response to treatment at the time of

developing symptomatic disease.

© 2006 Lippincott & Wilkins, Inc.