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Risk Stratification in Chronic Lymphocytic Leukemia

The Role of the Clinical Laboratory



Risk Assessment In CLL

Slide 34

November 2008

This table attempts to do that by using the risk factors we have talked about today.

If we look first at the right hand column, for low-risk CLL, we see that it is associated with early Rai stage, 13q- as the sole FISH abnormality, a mutated IgVH and negative for CD38 and ZAP-70. One exception, those cases with an IgVH mutation involving the 3-21 region are considered high-risk. Certainly these low-risk patients should not require any therapy or at best very low toxic or early intervention trials that are now being studied.

If I go to the left hand column for those high-risk patients, these patients may be at any Rai stage, associated with the worst FISH prognostic markers of 11q- and 17p-, typically being unmutated IgVH or having a mutation of the 3-21 region, and typically positive, but perhaps negative with CD38 and ZAP-70. These patients typically require standard chemotherapy and certainly transplant for those patients with 17p- will likely be considered.

The remaining patients would fall into an intermediate risk category.

Risk Assessment In CLL

 


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