Evaluation of: Shanafelt TD, Geyer SM, Bone NDet al.: CD49d expression is an independent predictor of overall survival in patients with chronic lymphocytic leukaemia: a prognostic parameter with therapeutic potential.Br. J. Haematol.140(5), 537–546 (2008). Chronic lymphocytic leukemia is a progressive disease for which there is no curative chemotherapy regimen. Progression may be either a late or an early event, occurring after more than 15 years or within 5 years from diagnosis. Counseling and management should be personalized on individual risk of progression, usually assessed by clinical staging and by investigating the presence of well-established biological markers: mutational status of immunoglobulin heavy variable region (IGHV) genes, chromososomal alterations as detected by fluorescence in situ hybridization, and expression of ZAP-70 and CD38. Several additional factors have been so far proposed as putative prognosticators, with the aim to find more reliable and easily measurable markers. Two recent studies indicate that CD49d is an independent prognosticator for overall survival and time-to-treatment, and that its value may be even more powerful than ZAP-70, CD38 or IGHV mutational status. CD49d is easily measurable by simple flow cytometer testing and is a potential therapeutic target, thanks to the availability of natalizumab, a US FDA-approved humanized monoclonal antibody for treatment of multiple sclerosis and Crohn's disease.