Chronic Lymphocytic Leukemia

Staging

Prognosis

CD38 positivity:

In an Italian study from 2001, it was shown in multivariate analysis that higher CD38 levels (cutoff here >30%) was correlated with shorter time to progression.

Dürig et al stidied the same in Nature in 2002 here. There was longer survival correlated with CD38 positivity (>20% positive) in univariate analysis but this did NOT hold up in multivariate analysis. Hgb and IgA levels did hold up, however.

It seems like a lot of the risk factors (CD38, IgA, hypermutations, sCD23, ZAP70 are closely correlated).

17p-

A nice study in Blood from 2009 looked at de novo 17p- CLL. In my opinion, the study showed that 17p- lends a poor prognosis but that it shouldn't be considered a stand-alone entity. Some reports have claimed that only Campath works for 17p- but this may be exaggerated, as shown in this study. Responses to rituximab, alkylators and fludarabine were acceptable to warrant these regimens in 17p-.

IGvH Hypermutations:

This study by Oscier et al (Blood, 2002) showed the risk associated with various risk factors, focusing on the IGvH mutations. The Hazard Ratios came to this. Unmutated patients had a 55% death rate at 10 years, compared to 6% for mutated patients.

Staging

This study shows by Stilgenbauer in NEJM 2000 shows survival based on cytogenetics.

Treatment

Indications (NCCN)

fcg

Links