Chronic lymphocytic leukemia (CLL) has a variable clinical course. Although the median survival of patients with this form of leukemia is around 10 yr (Fig. 1), in individual patients the prognosis is extremely variable, ranging from a very short to a normal life span. Thus, some CLL patients will have an excellent prognosis and will never require treatment, whereas in others the prognosis is poor and prompt treatment is required. Moreover, a large proportion of patients are now being diagnosed while asymptomatic and at a much younger age than previously. This results in longer overall survival, but it also poses special problems in respect to clinical management (1,2).
Clinical staging systems are the most useful prognostic parameters in CLL (3,4) (Table 1). However, they are not accurate enough to identify subgroups of patients with progressive CLL. Moreover, mechanisms causing citopenias are not taken into consideration, and this means that criteria used to define clinical stages do not necessarily parallel tumor mass. Since the introduction of staging systems, there has been a continuous effort to identify new prognostic factors in CLL. Thus, other variables have been investigated in the attempt to add prognostic power to clinical stages. Interestingly, some of these new prognostic variables are emerging from our biological understanding of this disease. However, it is not clear whether the newly identified prognostic parameters will replace classical clinical variables or, rather, will be integrated into a clinicobiological prognostic system. Assessment of prognostic factors should help us to decide whether a CLL patient needs to be treated and what therapeutic approach should be employed. In this chapter, our current knowledge of prognostic factors in CLL patients is reviewed.
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