Prognostic tools and risk factors in early-stage CLL—time for a change in treatment paradigm?

Chronic lymphocytic leukemia (CLL) is one of the most common lymphoid malignancies. Due to its biological heterogeneity, the course of the disease can range from incidentally diagnosed asymptomatic cases to highly symptomatic ones with life-threatening complications. The asymptomatic and low-symptomatic early-stage CLL patients can often be left under observation, while the patients with active and/or progressive disease require treatment. The criteria for initiating treatment that are commonly used nowadays were defined by the International Workshop on Chronic Lymphocytic Leukemia (iwCLL) in 2018.

Several prognostic scores have been created so far to identify patients at risk of rapid disease progression who may meet the criteria for treatment initiation soon after being diagnosed with CLL. As new serological and genetic risk factors are being discovered, new, more refined prognostic scores emerge.

This review presents the risk factors identified so far and existing prognostic scores, focusing on the early stage CLL. Finally, we discuss the relevance of the above factors for the present treatment algorithms.