CLINICAL IMPLICATIONS AND THE DEVELOPMENT OF NOVEL THERAPEUTICS
Currently used clinical staging systems defined by Binet help clinicians to monitor disease progression and decide when to treat patients. Because of difficulties distinguishing patients with poor prognosis at the onset of disease using these staging systems, the generally used practice is to wait to start therapy until the patient's clinical course becomes evident ("wait and watch" mode). However, the molecular and cellular markers that reflect intrinsic properties of leukemic cells present at the disease onset can help to distinguish patients that will follow worse clinical courses, regardless of the Rai and Binet categories at diagnosis. Although determination of IgVH gene mutation status is not yet routinely available, measurement of CD38 and ZAP-70 has become more widely available. Thus, although the wait-and-watch mode is still being followed in current clinical practice, it may substituted for by new more aggressive strategies in the future.
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