From the University of California, San Diego, Moores Cancer Center, La Jolla, California
Author's disclosure of potential conflicts of interest is found at the end of this article.
Address reprint requests to Thomas J. Kipps, MD, University of California, San Diego, Moores Cancer Center, 3855 Health Science Drive, Floor 4, Room 4305, Mailcode 0820, La Jolla, CA 92093-0820; e-mail: tkipps{at}ucsd.edu
Overview: The clinical behavior of patients with chronic lymphocytic leukemia is heterogeneous. Although some patients have indolent, asymptomatic disease, others develop progressive and/or symptomatic disease that requires therapy within a relatively short time after diagnosis. Early treatment of patients with indolent disease could cause development of therapy-related complications that might compromise their quality of life and/or survival. Defining markers that reliably can stratify patients into groups with good- or poor-risk disease could facilitate clinical trials to evaluate the potential benefit of early treatment. Understanding leukemia cellfeatures that are associated with resistance to standard therapy also could help identify patients who might respond better to alternative treatments strategies. This article will discuss some of the prognostic markers that can help identify patients who are at increased risk for requiring early treatment or for having an unfavorable response to standard chemotherapy. Also, it will summarize recent revisions to the National Cancer Institute-sponsored working group criteria for initiating treatment and assessing the response to therapy.
