Key prognostic factors include:
- the time it takes for the lymphocyte count to double;
- the value of the beta-2 microglobulin;
- the expression of the protein ZAP-70 and CD38 on leukemic cells.
As already mentioned, the most important prognostic information is that derived from the knowledge of the biological characteristics of leukemic cells. Some genetic characteristics have shown a predictive significance not only in suggesting how quickly the disease will grow, but also in addressing the most appropriate choice of treatment, once the CLL will need to be treated.
These studies define the biological profile of CLL and should be considered before the initiation of therapy. Among these, the most important ones in current clinical practice are:
- the evaluation of certain cytogenetic abnormalities (FISH analysis);
- measurement of change of the TP53 gene;
- assessment of mutation status of IgVH genes.