ABSTRACT
Chronic lymphocytic leukemia (CLL) is characterized by a highly variable clinical course. Many patients may survive for decades without requiring treatment, whereas others die from disease-related complications within a few months of diagnosis, despite appropriate therapy. A number of prognostic factors are used to assign patients to a risk group that predicts outcome and, therefore, may be used to direct therapy (1-4). Patients with lowrisk CLL (1) (Rai stage 0) often do not require therapy for many years after diagnosis and may eventually die of apparently unrelated causes. Many patients with intermediaterisk disease (Rai stages I and II) may also remain stable for years before requiring treat ment. However, most patients with high-risk CLL (stages III and IV) need therapy at diagnosis. Therefore, the issues differ among these groups: when to initiate treatment is the most important consideration for patients with early-stage disease, whereas selecting the best therapy is more important for patients with advanced-stage CLL.
