Biologic prognostic markers and their application in clinical trials and management of chronic lymphocytic leukaemia patients

Recent advances in the understanding of the pathogenesis and biology of chronic lymphocytic leukaemia (CLL) have identified and verified the prognostic significance of a large number of biomarkers, including immunoglobulin gene mutation status, expression of ZAP70 and CD38 and cytogenetics, which have all been verified as having powerful prognostic significance in determining time from initial diagnosis to requirement for therapy. Now that poor prognostic markers can be identifed, the challenge is to determine what should be done with these data. It is important that all available biomarkers be measured in ongoing clinical trials so that the optimal therapy can be selected for patients in particular prognostic subgroups. It is also possible that in the future poor prognostic markers can be used to determine whether a patient should be offered early therapy rather than a ‘watch and wait’ approach until symptoms appear. The results of ongoing and planned trials investigating the value of prognostic biomarke...