Prognostic and predictive markers in hematologic neoplasms. A review*

Introduction

Clinical behaviour, response to treatment and prognosis vary greatly not only between different hematopoietic neoplasms, but also within individual disorders. Establishing the proper diagnosis is just the first step in patients’ management. The decision about the initiation of therapy and type of treatment is often dictated by many additional parameters, which may vary from standard laboratory values to complex prognostic indices to new sophisticated molecular tests. With the improved treatment modalities many prior parameters lose their prognostic or predictive values. The development of targeted therapy dictates the need for constant update of the prognostic parameters and better definition of predictive markers, more and more at the molecular level.

The prognostic and predictive parameters can be broadly divided into standard and novel markers. The former include clinical data, laboratory values, morphologic and immunophenotypic features and the latter include chromosomal and molecular markers. In the first part of this review, individual parameters will be briefly described and the second part will summarize the prognostic and predictive values in most common hematologic neoplasms.

Clinical and laboratory parameters

Age



Age is an important prognostic marker in both indolent and aggressive hematologic tumours. Generally, the older the patient the worse the prognosis. This can be explained, at least partially, by decreased tolerance of older patients to toxic therapies and by comorbidities common in this age group. Patients with a history of chemotherapy (e.g. for solid tumours) have an inferior response to treatment of newly diagnosed hematologic malignancy. Older patients have also a “better” chance of suffering from preceding disorders, which often influence treatment options and prognosis, e.g. pre-existing myelodysplasia in elderly patients with acute myeloid leukaemia (AML). Considering age and prognosis, one has to remember that patient’s “fitness”/performance status and tolerance for treatment are more important than the actual age.

Patients with AML above 60 years of age have a poorer prognosis (older patients have a higher frequency of leukemic cells with multidrug resistance and unfavourable karyotypes). Paediatric patients with AML have slightly better results than adults with AML, and are currently reported to have disease-free survival (DFS)...


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