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Clinical staging is a simple and effective tool for assessing the prognosis of CLL patients. This system allows patients to be separated into low-, intermediate-, and high-risk groups, there are clear differences in estimated survival between the three groups:^1,2

 

Clinical staging cannot identify whether a patient is likely to run an indolent or progressive disease course, and prognosis can also be affected by many other factors e.g. age, gender, physical fitness and response to treatment. In addition, around 80% of patients are diagnosed with low-risk disease, which limits the prognostic value of clinical staging. As a result, a number of additional clinical and biological prognostic factors are now being investigated.

 

Retrospective studies have identified numerous markers that predict survival in CLL, including immunoglobulin gene mutational status, ZAP-70 and CD38 expression, cytogenetic changes and serum factors. The International Workshop on CLL do not yet recommend most of these factors for use in treatment decisions because they have not been verified in prospective randomised studies. One exception is the use of molecular cytogenetics. For example, the 17p chromosomal deletion affects the tumour suppressor gene p53 and is very strongly predictive of chemoresistance,⁶ and may therefore be used to guide the choice of therapy.

 

References

1. Binet JL, Auquier A, Dighiero G, et al. Cancer 1981;48:198–206.
2. Montserrat E. Hematology Am Soc Hematol Educ Program 2006;279–284.
3. Office for National Statistics. Interim Life Tables, United Kingdom. Available at http://www.statistics.gov.uk/downloads/theme_population/interim_Life/ILTUK0406Reg.xls#Notation!A1. Accessed October 2008.
4. Rai KR, Sawitsky A, Cronkite EP, et al. Blood 1975;46:219–234.
5. Grever MR, Lucas DM, Dewald GW, et al. J Clin Oncol 2007;25:799–804.