Prognosis

In the above video Dr George Follows discusses testing, diagnosis and genetic profiling in CLL.

Much discussion is required between the patient and doctor when understanding where you are, as tests may be better at predicting for populations and there is much individual variation to consider.

Q1) What are the most important clinical tests for CLL patients to take?
Q2) What genetic techniques can we utilise to help diagnose CLL patients?
Q3) Can a CLL patient’s genetic status change as their disease develops?
Q4) Using the results from genetic testing, how much can CLL patients understand about the likelihood if their disease will progress?

 

Prognostic Markers 

Cardiff University CLL group are currently working on a update on prognostic markers  for 2015 which will soon be added to the article below written by Professor Andrew Pettitt circa 2006.  

Making sense of prognostic factors in CLL

Professor Andrew Pettitt,
Consultant Haematologist at the Royal Liverpool University Hospital

Natural history of CLL  circa 2006

Like many other types of indolent non-Hodgkin’s lymphoma, CLL is cancer of immune cells called B-lymphocytes. However, the exact identity of the normal counterpart of the CLL cell is still unclear and we do not know what actually causes the disease. The current idea is that CLL probably starts as an immune response, perhaps to bacteria or components of normal body cells, which for some reason is not switched off and over time turns into a malignant process. CLL is usually a slowly growing cancer. It almost always involves the blood and bone marrow and sometimes also the lymph nodes, liver and spleen. Problems can arise for several reasons. One of the most important complications of CLL is malfunctioning of the immune system. This can take two forms: under activity against things it should be active against (e.g. bacteria, fungi and viruses ) and over-activity against things it should not be active against (e.g. red cells and platelets). Another problem that can occur is that the bone marrow can become so crowded with CLL cells that its function becomes impaired. This results in the reduced production of red cells, platelets and normal white blood cells. Finally, the lymph nodes, liver or spleen can become enlarged to the point of becoming uncomfortable, and enlarged lymph nodes can press on important internal structures.

Treatment is usually reserved for patients with symptoms, rapid progression or complications, as there is no current evidence that treating patients without any of these features does any good. Chemotherapy is effective in most patients to begin with. However, relapse is inevitable. Many patients respond to treatment the second and third time round but the chances of a good response become lower each time the disease comes back, and eventually the disease becomes resistant to therapy. A significant proportion of patients with progressive CLL eventually succumb to infection due to impaired immunity.

A useful summary of these Prognostic Factors is shown in the following table:-

Prognostic Indicator

Non-aggressive

Intermediate

Agressive

IgVH

Mutated

 

Unmutated

ZAP-70

Less than 20% (-ve)

 

More than 20% (+ve)

CD38

Less than 30% (-ve)

 

More than 30% (+ve)

FISH

Normal karotype

Trisomy 12

 

Rai Stage

Stage 0, 1

Stage 2

Stage 3, 4

β2M

Less than 2.0

 

More than 4.0

Binet Staging

Stage A

Stage B

Stage C

Lymphocyte Doubling time

More than 12 months

 

Less than 12 months

 

Read the full article