Genetic polymorphisms, chronic lymphocytic leukemia, and the future: are we there yet?*

In this issue of the Revista Brasileira de Hematologia e Hemoterapia, Holanda et al.1 investigated the hypothesis that polymorphisms of the mannose-binding lectin 2 (MBL2) gene are associated with infections in patients with chronic lymphocytic leukemia (CLL). The authors did not find a correlation between genetic changes and frequency of infection in a cohort of 116 patients. Patients with CLL have a highly variable clinical course: the majority will have a slowly progressive disease that will not require therapy for several years. However, a small but important minority will present with rapidly progressive disease. Continued efforts have aimed at identifying clinical and laboratory parameters that can predict the clinical evolution of CLL patients and their eventual need for treatment. Most clinicians still rely primarily on clinical staging systems (Rai and Binet) to determine the time for initial therapy. There are multiple laboratory parameters that have some degree of correlation with prognosis, including ZAP-70, the CD38 protein expression in CLL cells, and mutational status of the immunoglobulin heavy chain (IgVH) gene, but only the presence of cytogenetic abnormalities has been well validated and can be easily applied in clinical practice for assessment and prognosis. CLL patients have immune abnormalities that increase the rate of infections as well as of autoimmune events. Most will experience an infectious event in the course of their disease, and approximately half will die from an infectious cause.2 The importance of infections cannot be understated, and identification Scientific comment