Usefulness of Risk Stratification in the Treatment of Patients with Chronic Lymphocytic Leukemia

Major advances in the understanding of chronic lymphocytic leukemia (CLL) biology, prognosis, and therapy have drastically changed the management of CLL in the past 2 decades. As a heterogenous disease, approximately two thirds of CLL will eventually progress and require therapy. Cytogenetic aberrations, especially 17p–, 11q–, and the mutational status of the variable region of the immunoglobulin heavy chain gene, are the strongest independent prognostic factors to predict CLL progression. Asymptomatic patients with early-stage disease will need to be risk stratified into low- or high-risk categories for counseling, follow-up, and referral to a clinical trial. Treatment with chemoimmunotherapy is required for patients with CLL with progressive or symptomatic diseases. Progressive diseases with high-risk features in relatively healthy patients might do best with allogeneic stem cell transplantation with reduced-intensity conditioning regimens.