LAUSR

The discovery of genetic lesions for chronic lymphocytic leukemia (CLL) is a chance to generate inclusive models integrating a combination of biomarkers [1–5]. Prognostic models were primarily designed to inform clinical decisions, however, their use in day-by-day practice remains undefined [2,4]. The reasons for this limitation have been extensively reviewed in a recently published Cochrane systematic review [6]. The analysis reveals that the current standards of prognostic model development (i.e., predictor assessment, outcome definition, and the relevant performance measures) were often misapplied. Moreover, it is not surprising that prognostic models typically established in the chemoimmunotherapy period were found to be useless in patients receiving targeted agents [7]. A model should be frequently updated and tailored to a particular population of CLL patients to sustain its predictive effectiveness, despite ongoing changes in the treatment paradigm of the disease [8–10]. Finally, frailty is an important feature not included in prognostic models which significantly affects the outcome of patients diagnosed with CLL. Retrospective studies have shown that in patients with CLL treated with new targeted agents (i.e., ibrutinib), comorbidities impact on prognosis and add discriminatory strength to the CLL-International Prognostic Index (CLL-IPI) [11,12].