1. ¹Division of Hematology, Mayo Clinic, Rochester, MN, USA
2. ²Department of Leukemia, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
3. ³Department of Hematology, University of Liverpool, Liverpool, UK
4. ⁴Abteilung Innere Medizin III, Universitätsklinikum Ulm, Ulm, Germany

Correspondence: Dr NE Kay, Professor of Medicine, Division of Hematology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. E-mail: kay.neil@mayo.edu

Received 23 January 2007; Revised 13 April 2007; Accepted 9 May 2007; Published online 14 June 2007.

Abstract

The management of chronic lymphocytic leukemia (CLL) has historically relied on 'watchful waiting' and palliative approaches to therapy. However, the course of disease is highly variable and a substantial proportion of patients with early-stage CLL develop rapidly progressive disease requiring therapy. In recent decades, numerous clinical and biological prognostic markers that are predictive of decreased survival outcomes, disease progression and/or resistance to therapy, and that may play a role in defining the subgroups of patients with 'high-risk' CLL have been identified. At the same time, highly effective treatment modalities have become available with the advent of chemoimmunotherapy combinations and allogeneic stem cell transplantation. Thus, we are approaching an era when patients with CLL may potentially benefit from individualized risk assessments based on prognostic markers and when specific therapies may be offered to the subgroup of patients with high-risk disease. This review provides a brief overview of newer biological prognostic markers, discusses the challenges associated with identifying the subgroup of patients with high-risk CLL and further aims to provide recommendations on how prognostic markers may be used to assess high-risk subgroups in different clinical situations in CLL.