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Abstract
CLL is extremely heterogeneous in its clinical course, with some patients living decades
with no need for treatment whilst others have a rapidly aggressive clinical course.
A major focus of research has been to try to identify those biological factors that
influence this heterogeneity. The goal of therapy has been to maintain the best quality
of life and treat only when patients become symptomatic from their disease. For the
majority of patients this means following a "watch and wait" approach to determine
the rate of progression of the disease and assess for development of symptoms. Any
alteration to this approach will require identification of criteria that define patients
sufficiently "high-risk" that they gain benefit by introduction of early therapy.
The use of molecular profiling to suggest particular therapies is currently appropriate
only in defining the treatment of the minority of patients with 17p deletions or p53
mutations and in all other circumstances remains a clinical trial question.
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