Department of Internal Medicine, Division of Hematology, Mayo Clinic, Rochester, MN 55905, USA.
Hematology Am Soc Hematol Educ Program. 2009:421-9. doi: 10.1182/asheducation-2009.1.421.
The clinical course of patients with chronic lymphocytic leukemia (CLL) is heterogeneous, with some patients experiencing rapid disease progression and others living for decades without requiring treatment. Clinical features and molecular/biologic factors such as ZAP-70, immunoglobulin heavy chain (IGHV) gene mutation status, and cytogenetic abnormalities on fluorescent in situ hybridization (FISH) have been found to be robust predictors of treatment-free survival and overall survival among newly diagnosed patients. Beyond their widely recognized value for providing insight into disease biology and utility for stratifying patient risk in clinical trials, these prognostic tools play an important role in the current counseling and management of patients with CLL. Recent studies have focused on how to combine the results of multiple prognostic assays into an integrated risk stratification system and explored how these characteristics influence response to treatment. This chapter reviews the available tools to stratify patient risk and discusses how these tools can be used in routine clinical practice to individualize patient counseling, guide the frequency of follow-up, and inform treatment selection.
慢性淋巴细胞白血病（CLL）患者的临床病程存在异质性，部分患者疾病进展迅速，而部分患者在无需治疗的情况下可生存数十年。临床特征和分子/生物学因素，如 ZAP-70、免疫球蛋白重链（IGHV）基因突变状态和荧光原位杂交（FISH）上的细胞遗传学异常，已被发现是新诊断患者无治疗生存和总生存的可靠预测因素。除了在疾病生物学方面具有广泛的认识价值，以及在临床试验中用于分层患者风险的实用性外，这些预后工具在当前 CLL 患者的咨询和管理中也发挥着重要作用。最近的研究集中在如何将多个预后检测结果组合成一个综合风险分层系统，并探讨这些特征如何影响治疗反应。本章回顾了用于分层患者风险的现有工具，并讨论了如何在常规临床实践中使用这些工具来个性化患者咨询，指导随访频率，并为治疗选择提供信息。
