From the University of California-San Diego Medical Center, Moores Cancer Center, La Jolla, CA
Author's disclosure of potential conflicts of interest are found at the end of this article.
Address reprint requests to Thomas J. Kipps, MD, PhD, Professor of Medicine and Deputy Director of Research Operations, University of California-San Diego Medical Center, Moores Cancer Center, 3855 Health Sciences Drive, La Jolla, CA 92093; e-mail: tkipps{at}ucsd.edu
Overview: The clinical course of patients with chronic lymphocytic leukemia is heterogeneous. Whereas some patients will have progressive disease that requires therapy within a relatively short time after diagnosis, others can enjoy a highly indolent clinical course and not require leukemia-directed therapy for many years, if at all. The staging criteria of Rai et al or Binet et al have proven utility in assessing the imminent risk for disease-related complications, need for therapy, and survival. However, either staging system cannot stratify patients into subgroups that have different risks for disease progression. This is particularly apparent for newly diagnosed patients, who most typically have early-stage, asymptomatic, and hence "low-risk" disease. A large subgroup of such patients will evolve relatively rapidly into having more advanced, aggressive and eventually fatal disease. This article summarizes recent advances that allow us to segregate cases into subgroups that differ in relative risk for disease progression, response to therapy, duration of response, and/or survival. In addition, it provides perspective on how to incorporate these advances into our current management of patients with chronic lymphocytic leukemia.
