PMID- 9499672
OWN - NLM
STAT- MEDLINE
DCOM- 19980402
LR  - 20071115
IS  - 0390-6078 (Print)
IS  - 0390-6078 (Linking)
VI  - 82
IP  - 6
DP  - 1997 Nov-Dec
TI  - Prognostic value of biological variables in B-cell chronic lymphocytic leukemia. 
      Can we improve upon clinical parameters?
PG  - 705-9
AB  - BACKGROUND AND OBJECTIVE: Cellular and molecular features including tumor cell 
      proliferation, immunophenotype, adhesion molecule expression and release, and 
      karyotypic abnormalities have been linked with survival in B-cell chronic 
      lymphocytic leukemia (CLL) patients. Although information provided from these 
      studies makes it possible to better appreciate the biological heterogeneity of 
      the disease, it is not clear whether they may substitute clinical features in the 
      prognostic assessment of CLL patients. The objective of this article is to 
      analyze the performance of new prognostic variables, keeping in mind that 
      clinicians should give priority to less expensive biological assays. INFORMATION 
      SOURCES: In the present review, we examined personal papers in this field, and 
      articles or abstracts published in journals covered by the Science Citation Index 
      and Medline. STATE OF ART: Clinico-prognostic staging systems do not provide 
      criteria accurate enough to identify patients with progressive disease. Although 
      several in vitro methods have been utilized to evaluate tumor cell proliferation 
      and to correlate this parameter with long-term survival, it is difficult to 
      translate the results of kinetic studies into prognosis. Interestingly, 
      prognostic implications of kinetic parameters are exemplified by clinical studies 
      based on lymphocyte doubling time (LDT). Attempts to correlate immunophenotype 
      with prognosis have yielded inconclusive results. This is probably due to the 
      absence of strict immunological criteria. The membrane instability of CD23, 
      rapidly cleaved into a soluble form, provides a highly specific and reliable 
      serum marker. Expression of myelomonocytic antigens (i.e., CD11b, CD13) appears 
      to be restricted to patients with CD5- CLL. Both cellular expression and release 
      in the serum of some adhesion molecules (i.e., CD54, CD44 standard) have been 
      linked with prognosis. The increased use of fluorescence in situ hybridization 
      (FISH) techniques, which make it possible to identify karyotypic abnormalities 
      even in cases with inadequate mytoses, has contributed to a better definition of 
      incidence and clinical relevance of karyotypic abnormalities in CLL. Trisomy 12 
      is significantly associated with atypical morphological and/or immunological 
      features, high proliferative activity and poor prognosis; the prognostic effect 
      of 11q deletions is consistent in patients under 55 years of age. Usually, in 
      absence of the rearrangement of the bcl-2 locus, B-CLL cells express bcl-2 gene 
      product, whose intracellular levels do not correlate with clinical stages but do 
      correlate with survival, thereby suggesting a possible independent prognostic 
      value. Finally, p53 tumor suppressor gene has been associated with resistance to 
      therapy with fludarabine. PERSPECTIVES: Even though prognostic assessment of CLL 
      patients is generally based on clinical staging systems new biological parameters 
      which reflect the clinical heterogeneity of the disease are under evaluation. 
      Whether in the future clinicians will substitute biological variables for 
      clinical features is matter of debate. The prognostic value of biological 
      parameters is hampered, in some instances, by the small number of patients 
      presenting these features (i.e., 11q deletions in 20%, p53 mutations in 15%). 
      More likely, biological parameters might be incorporated into clinico-prognostic 
      models thus leading to the formulation of a clinical-biological system for CLL.
FAU - Molica, S
AU  - Molica S
AD  - Divisione Ematologia, Azienda Ospedaliera Pugliese-Ciaccio, Catanzaro, Italy.
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Italy
TA  - Haematologica
JT  - Haematologica
JID - 0417435
SB  - IM
MH  - Cell Division/physiology
MH  - Humans
MH  - Immunophenotyping
MH  - Karyotyping
MH  - Leukemia, Lymphocytic, Chronic, B-Cell/*physiopathology
MH  - Prognosis
RF  - 76
EDAT- 1998/03/21 00:00
MHDA- 1998/03/21 00:01
CRDT- 1998/03/21 00:00
PHST- 1998/03/21 00:00 [pubmed]
PHST- 1998/03/21 00:01 [medline]
PHST- 1998/03/21 00:00 [entrez]
PST - ppublish
SO  - Haematologica. 1997 Nov-Dec;82(6):705-9.