Chronic lymphocytic leukemia is characterized by a variable clinical course that cannot be predicted accurately by clinical staging systems in individual patients. This prompted the investigation of other prognostic factors capable of adding predictive power to clinical staging systems or even substituting them. Among the clinical and biological markers found initially, genomic aberrations and the mutational status of immunoglobulin genes demonstrated a high level of prognostic prediction in CLL. However, the techniques employed in these studies are laborious and inaccessible for most hematology-oncology facilities, which motivated the hunt for surrogate markers. Among the potential surrogates, CD38 and Zap-70 play an independent prognostic role in CLL, with a predictive power as precise as (or even better than) the immunoglobulin mutational profile, pointing for its replacement in the near future. Novel factors such as LPL, LPL/ADAM29 and Vimentin have showed quite attractive preliminary results, but still wait for validation in further series of patients. Besides the recognition of powerful biological markers, the clinical staging systems should not be abandoned so far.
Chronic lymphocytic leukemia; prognosis