Moving from clinical to biological staging for the management of chronic lymphocytic leukemia

Chronic lymphocytic leukemia (CLL) is a complex disease with a very heterogeneous outcome. It is generally assumed that not all patients with CLL die of their disease. However, a more recent analysis of data showed that patients who have progression of their CLL die predominantly of complications of the disease, especially from infections. Over the last decade, major advancements in our understanding of this hematologic malignancy have occurred. From the clinician's perspective the importance of the new knowledge is how it affects treatment. The assessment of prognosis in patients with CLL has been revolutionized. Thus, besides classical clinical parameters a number of biological features have shown to correlate with prognosis and to add prognostic value to Rai's and Binet's clinical stages.