Division of Hematology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Leuk Lymphoma. 2021 Jun;62(6):1289-1301. doi: 10.1080/10428194.2020.1869966. Epub 2021 Jan 7.
Chronic lymphocytic leukemia (CLL) is a mature B-cell malignancy characterized by marked heterogeneity. Discoveries in disease biology over the past two decades have helped explain clinical variability and heralded the arrival of the targeted therapy era. In this article, we review improvements in risk stratification which have coincided with this progress, including individual biomarkers and their incorporation into prognostic models. Amidst an ever-expanding list of biomarkers, we seek to bring focus to the essential tests to improve patient care and counseling at particular times in the disease course, beginning with prognosis at diagnosis. The majority of patients do not require treatment at the time of diagnosis, making time-to-first-treatment a key initial prognostic concern. Prognostic and predictive biomarkers are then considered at subsequent major junctures, including at the time of treatment initiation, while on therapy, and at the time of relapse on novel agents.
慢性淋巴细胞白血病（CLL）是一种成熟 B 细胞恶性肿瘤，其特征是显著的异质性。在过去的二十年中，疾病生物学方面的发现有助于解释临床变异性，并预示着靶向治疗时代的到来。在本文中，我们回顾了与这一进展同时发生的风险分层的改善，包括个体生物标志物及其纳入预后模型。在不断扩展的生物标志物列表中，我们试图关注基本测试，以在疾病过程中的特定时间点改善患者的护理和咨询，首先是在诊断时进行预后评估。大多数患者在诊断时不需要治疗，因此首次治疗时间是一个关键的初始预后关注点。然后在后续的重要节点考虑预后和预测生物标志物，包括在开始治疗时、治疗期间以及新型药物治疗复发时。
