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2014, Number 3

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Rev Hematol Mex 2014; 15 (3)

B-cell chronic lymphocytic leukemia: A personalized view of the clinical and molecular aspects

Valdespino-Gómez VM

Language: Spanish
References: 42
Page: 103-121
PDF size: 725.69 Kb.


ABSTRACT

B-cell chronic lymphocytic leukemia (B-CLL) is the most common leukemia in western countries, and B-CLL patients show a heterogeneous clinical presentation and course. It has been demonstrated that specific clinical course of B-CLL patients is associated to personalized variables related to the biological characteristics of their predominant neoplastic clones and with patients fitness as well as their global response against the disease. The great viability in the clinical course of B-CLL patients has motivated scientific efforts to search new prognostic markers, diagnostic parameters, and treatment options. The cellular variables of the B-CLL cells can be classified in microenvironmental-interaction cell alterations, chromosomal abnormalities and genetic, epigenetic and proteomic alterations. The main patient’s parameters participating in the clinical course of the disease as immunological response, the tolerability and the response to the treatment toxicity, which are related to the patient’s physical fitness, age, performance status, organ function, as well as the comorbidities and life expectancy; these parameters are used to predict the clinical evolution of the disease, and to choose the treatment strategy. The rational selection of the therapeutic regimen of a B-CLL particular patient implies to register the main patient’s parameter participating, the cellular variables of the B-CLL cells and the interactions of which both biological variables affect the real-time clinic state of the patient, such as the clinical and activity status of disease. The treatment will be based to the use modern approved therapeutic algorithms to produce more effective responses with minor risk, obtain a complete clinical response with the minimal residual disease elimination. In conditions of refractory disease, the patient should be directed to a designed clinical trial, where their specific target will affect specific pathological biomarker of tumoral clones of the disease progression.


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