Chronic lymphocytic leukemia – clinical course, prognostic parameters, prognostic markers

Abstract

An increase in the number of patients diagnosed with cancer and death caused by malignant tumors has been observed in the world in recent years. The process of tumor formation is very complex and multistage. The pathogenesis of hematopoietic system diseases is mostly associated with anomalies in the signaling pathways, genetic and epigenetic modifications. The gene mutations responsible for DNA methylation and acetylation and methylation of histone proteins play an important role in the formation of hematologic malignancies. Disorders of the basic stages of hematopoiesis may result in uncontrolled proliferation and differentiation, and tumor initiation. Disorders of DNA repair mechanisms, as well as cell cycle deregulation may increase the risk of hematological malignancies. The basic division of hematologic malignancies are by their morphological traits, cytochemical and immunophenotyping of cells. New reports of specific genetic and molecular disorders may become therapeutic targets and be used to monitor the remission and progression of diseases. Chronic lymphocytic leukemia (CLL) represents about 30% of adult leukemia and is a disease of the elderly people. CLL is usually diagnosed between 60 and 70 years of age, with a male to female ratio of 2:1. The disease occurs more frequently in Caucasians than in the Black and Asians population. The clinical course of the disease usually presents as a chronic condition and is very diverse. The deregulation of the immune system is manifested by reduced resistance, and the possibility of the emergence of autoimmune processes depends on the degree of development of the cancer. In most cases the therapeutic goal is to achieve complete remission and overall survival. Mutations of the immunoglobulin heavy chain variable genes (IGVH), blood biochemical markers, antigen CD38 and ZAP-70 expression and chromosomal abnormalities are amongst the most important prognostic parameters in CLL. The main objective of this review is to attempt to summarize the current information on clinical symptoms identified by genetic abnormalities and prognostic markers among patients with chronic lymphocytic leukemia.