Service d’hématologie biologique, Hôtel-Dieu, 1, place du Parvis-Notre-Dame, 75181 Paris cedex 04.
The identification of useful prognostic factors in CLL is difficult for two reasons. First, studies based on survival require a too long period of follow up considering the natural history of this disease. An alternative to the assessment of survival might be the identification of surrogate markers.
Moreover, the efficacy of recent treatment regimen may justify to use a more intensive regimen based on the presence of markers of poor prognosis.
Rai and Binet clinical classifications remain the only criteria used to date for treatment decision. The more recently identified biological parameters are not yet considered. However, the value of these new biological prognostic factors needs to be assessed by multivariate studies. The most promising research area seems to be the identification of markers reflecting the proliferation-apoptosis inbalance (p27 – TK) or the natural history of the disease (IgVH mutation). Because of the great heterogeneity of Binet stage A population, the identification of prognostic factors should allow to propose earlier treatments for patients with poorer life expectancy.