Clinical heterogeneity reflects biologic diversity in chronic lymphocytic leukemia

As the incidence of B cell chronic lymphocytic leukemia increases in an aging population, it becomes more important to re-evaluate our understanding of the disease process and current therapy. Previous treatment strategies have been, for the most part, unsuccessful in prolonging survival and thus new approaches are needed. More intense cellular and molecular research on the biologic diversity of this neoplasm will further our understanding of the causes of clinical heterogeneity and refine our ability to predict progression. New approaches, based on alterations of neoplastic cell growth by cytokines or chemotherapeutic agents, may enable clinicians to 'customize' individual treatments based on the stages of CLL B cell differentiation and our understanding of factors involved in the regulation of apoptosis and proliferation at those stages. Taken together, these efforts should ultimately yield much new information that will lead to reduced morbidity and mortality in B-CLL, the most common form of human leukemia.