[Chronic lymphocytic leukemia]

Chronic lymphocytic leukemia results from a proliferation/accumulation of monoclonal B lymphocytes. The diagnosis is easily made on blood cytology and immunophenotype. The complexity of mechanisms which govern the clonal evolution translate in a large pronostic diversity on long-term outcome, with a life expectancy ranging from a few years to more than 25 years in the most indolent forms. Prognostic appraisal is currently based on clinical and hematological presentation, whereas cytogenetics, immunoglobulin gene status, expression of proteins involved in cell proliferation such as ZAP70 or CD38 provide more precise but non routine indications. Although there is a lot of effective drugs against the clonal process, any of them are curative, and long term benefit of treatment tailored on individual prognostic features still deserves further studies. Therefore, current treatment recommendations aim at sustaining quality of life in elderly patients, whereas response quality and length are the main targets in younger ones.