The Clinical Significance Of Genetic Abnormalities In Chronic Lymphocytic Leukemia

Interpretation of the clinical significance of genetic abnormalities is dependent on a number of variables. These include the techniques used to identify the abnormality and whether analysis is univariate or multivariate, with account taken of known prognostic factors such as clinical stage, lymphocyte doubling time, B2 microglobulin, and most recently, VH gene status. A further problem is the choice of outcome measure, which may be time to disease progression, time to first treatment, or overall survival. The last would seem to be the most significant, but many patients with CLL are elderly and die of unrelated causes. A particular problem in CLL concerns patients with stage A disease whose date of diagnosis depends on the timing of a routine blood count performed for an incidental reason. Studies that include a large percentage of patients with stage A disease have a median follow-up time of less than 5 years and that use time to progression or treatment as an endpoint are difficult to interpret.

Data from the first and second International Working Party on Chromosomes in CLL, which included large numbers of patients with prolonged follow-up periods, found the median survival of patients with a normal karyotype to be 15 years,

Table 6-6. Incidence and Clinical Significance of Genetic Abnormalities in Chronic Lymphocytic Leukemia
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