References

1. IWCLL-Initiated Working Group on Prognostic and diagnostic parameters in CLL: Perspectives on the use of new diagnostic tools in the treatment of chronic lymphocytic leukemia. Blood 107:859-61, 2006.

2. Cheson BD, Bennett JM, Grever M, et al.: National Cancer Institute-Sponsored Working Group Guidelines for CLL: revised guidelines for diagnosis and treatment. Blood 87:4990-4997, 1996.

3. Chronic lymphocytic leukemia: recommendations for diagnosis, staging and response criteria. International Workshop on CLL. Ann Intern Med 110: 236-238, 1989.

4. Damle RN, Wasil T, Fais F, et al.: IgV gene mutation status and CD38 expression as novel prognostic indicators in CLL. Blood 94:1840-1847, 1999.

patient to actively participate in the decision-making process, we would engage the patient in a discussion of whether he/she would be willing to enter any prospectively conducted clinical trials aimed at elimination of minimal residual disease with targeted monoclonal antibody therapy in an adjuvant setting, or with hematopoietic stem cell transplantation following a nonmyeloablative conditioning regimen. The latter courses are still unproven for their ability to achieve a cure or even to improve the duration of remission and survival time, but are accompanied by a higher likelihood of treatment-related morbidity and mortality.

If, on the other hand, we are dealing with an older patient whose actuarial life expectancy is considered to be about 10 years, aggressive and curative therapeutic approaches would be inappropriate, because of a treatment-associated significant incidence of morbidity and mortality. In those cases, a palliative approach is indicated, with the objective of relief of symptoms and reduction of body burden of overall tumor mass, while, to a certain extent, preserving the quality of life. Additionally, if these patients have other major comorbid conditions, our treatment objective would be rather conservative, and palliative therapy aimed at relief of symptoms but with less potential toxicity would be the recommended method of management.

5. Hamblin TJ, Davis Z, Gardiner A, Oscier DG, Stevenson FK: Unmutated IgV(H) genes are associated with a more aggressive form of CLL. Blood 94:1848-1854, 1999.

6. Crespo M, Bosch F, Villamor N, et al.: ZAP-70 expression as a surrogate for immunoglobulin-variable region mutations in CLL. N Engl J Med 348: 1764-1775, 2003.

7. Rassenti LZ, Huynh L, Toy TL, et al.: ZAP-70 compared with immunoglobulin heavy chain gene mutation status as a predictor of disease progression in CLL. N Engl J Med 351:893-901, 2004.

8. Dohner H, Stilgenbauer S, Benner A, et al.: Genomic aberrations and survival in patients with CLL. N Engl J Med 343:1910-1916, 2000.

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