Prognosis and survival for chronic lymphocytic leukemia
People with chronic lymphocytic leukemia (CLL) may have questions about their prognosis and survival. Prognosis and survival depend on many factors. Only a doctor familiar with a person’s medical history, type of cancer, stage, characteristics of the cancer, treatments chosen and response to treatment can put all of this information together with survival statistics to arrive at a prognosis.
A prognosis is the doctor’s best estimate of how cancer will affect a person, and how it will respond to treatment. A prognostic factor is an aspect of the cancer or a characteristic of the person that the doctor will consider when making a prognosis. A predictive factor influences how a cancer will respond to a certain treatment. Prognostic and predictive factors are often discussed together and they both play a part in deciding on a treatment plan and a prognosis.
The following are prognostic and predictive factors for CLL.
A lower stage at the time of diagnosis is a more favourable prognostic factor.
Leukemia cells in the bone marrow @(Model.HeadingTag)>
Abnormal blood cells (called leukemia cells) can form different patterns in the bone marrow. When the leukemia cells are more spread out (called a diffuse pattern) it is a less favourable prognostic factor. Leukemia cells that are in small clumps (called a nodular pattern) or leukemia cells between normal cells (called an interstitial pattern) are more favourable prognostic factors.
Elderly people have a less favourable prognosis.
Men have a less favourable prognosis than women.
Chromosome changes @(Model.HeadingTag)>
Deletion of part of chromosome 13, with no other chromosome abnormalities, is a more favourable prognostic factor. Deletion of parts of chromosome 11 or 17 is a less favourable prognostic factor.
Prolymphocytic transformation @(Model.HeadingTag)>
A prolymophocyte is an early form of a lymphocyte. A higher number of prolymphocytes in the blood is called prolymphocytic transformation. It has a less favourable prognosis.
Lymphocyte doubling time @(Model.HeadingTag)>
Lymphocyte doubling time is the time it takes for the lymphocyte count to double. A lymphocyte doubling time of more than 6 months is a more favourable prognostic factor.
Areas of lymphatic tissue affected @(Model.HeadingTag)>
The areas of lymphatic tissue are the spleen, liver and lymph nodes in the neck, underarm area and groin. Having fewer areas of lymphatic tissue areas affected by CLL is a more favourable prognostic factor.
Protein levels @(Model.HeadingTag)>
The following protein levels mean a more favourable prognosis:
- a low blood level of beta-2-microglobulin
- a low number of CLL cells have the proteins CD38 (cluster of differentiation 38) or ZAP-70 (zeta-associated protein 70)
IGHV gene mutation @(Model.HeadingTag)>
CLL cells with a changed, or mutated, gene for IGHV (immunoglobulin heavy chain variable region) have a more favourable prognosis.
Richter’s syndrome @(Model.HeadingTag)>
Richter’s syndrome, or a Richter transformation, occurs when CLL develops into an aggressive non-Hodgkin lymphoma, usually a diffuse large B-cell lymphoma (DLBCL). Richter’s syndrome is a less favourable prognostic factor.
Performance status @(Model.HeadingTag)>
People with a good
American Cancer Society. Leukemia - Chronic Lymphocytic. Atlanta, GA: American Cancer Society; 2013: http://www.cancer.org/acs/groups/cid/documents/webcontent/003111-pdf.pdf.
Borthakur G, O'Brien S . Treatment of chronic lymphocytic leukemia and related disorders. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 9: pp. 121-119.
National Cancer Institute. Chronic lymphocytic leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
Wierda WG, O'Brien S . Chronic lymphocytic leukemia. DeVita VT Jr, Lawrence TS, & Rosenberg SA. Cancer: Principles & Practice of Oncology. 9th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014: 134: pp. 1973-1987.