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Chronic Lymphocytic Leukemia pp 53–65Cite as

Prognostic Markers

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Part of the book series: Hematologic Malignancies ((HEMATOLOGIC))

Abstract

CLL is a clinically and biologically heterogeneous disease. Various clinical risk scores have been derived including most recently the CLL-IPI. Besides, a myriad of molecular prognostic and predictive markers have been identified, but only the presence of either deletions of chromosome 17p and/or mutations in the TP53 gene is currently used in routine clinical practice to direct therapy and recommended by various national and international guidelines. Other candidate prognostic or predictive markers will be discussed. For example, a subgroup of patients with hypermutated immunoglobulin (IgHV) locus demonstrates very favourable prognosis or functional cure following chemo-immunotherapy in the frontline setting. Therefore, testing for the IgHV status should be considered prior to choosing first-line treatment. Conversely, patients presenting with complex karyotypic abnormalities have a poor prognosis even with the novel targeted agents and might be considered for experimental approaches or bone marrow transplantation. The possible consequence of the screening results on follow-up, therapy, and quality of life should be discussed with patient and relatives before requesting prognostic testing.

It is expected that the systematic use of massively parallel next-generation sequencing within clinical trials combined with rigorous standardisation of laboratory technologies will identify further biomarkers for risk stratification. However, to achieve statistically and clinically meaningful results, large number of patients will be required. Altogether, this holds the promise that a more individualised treatment approach on the basis of prognostic profiles will be possible.

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Authors and Affiliations

  1. Department of Oncology, University of Oxford, Oxford, UK

    Anna Schuh

  2. Oxford University Hospitals NHS Foundation Trust, Oxford, UK

    Anna Schuh

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  1. Anna Schuh
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Editors and Affiliations

  1. Department I of Internal Medicine, University of Cologne, Cologne, Nordrhein-Westfalen, Germany

    Michael Hallek

  2. Department I of Internal Medicine, University of Cologne, Cologne, Nordrhein-Westfalen, Germany

    Barbara Eichhorst

  3. Division of Molecular Pathology, The Institute of Cancer Research, London, UK

    Daniel Catovsky

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Schuh, A. (2019). Prognostic Markers. In: Hallek, M., Eichhorst, B., Catovsky, D. (eds) Chronic Lymphocytic Leukemia. Hematologic Malignancies. Springer, Cham. https://doi.org/10.1007/978-3-030-11392-6_4

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