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Chronic lymphocytic leukemia

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Staging chronic lymphocytic leukemia

Staging is a way of describing or classifying a cancer based on the extent, or amount, of cancer in the body. Cancers that form solid tumours are given numbered stages based on the size of the tumour and if the cancer has spread to lymph nodes or other parts of the body.

Staging for chronic lymphocytic leukemia (CLL) is different because it does not form a solid tumour. It is a cancer of the cells in the blood-forming tissue in the bone marrow. The stage of the disease is defined based on blood cell counts and amount of lymphoid tissues involved.

The 2 staging systems for CLL are the Rai staging system and the Binet staging system. Both systems are based on the numbers of lymphocytes, red blood cells and platelets in the blood and bone marrow.

  • A high number of lymphocytes in the blood is called lymphocytosis.
  • A low number of red blood cells is called anemia.
  • A low number of platelets in the blood is called thrombocytopenia.

Sometimes doctors talk about a risk group for CLL. The risk group describes how likely the CLL is to worsen and need treatment. If the CLL worsens, doctors may change the stage.

Rai staging system

The Rai staging system has 5 levels (0–IV) that are based on the numbers of lymphocytes, red blood cells and platelets. It also considers if the lymph nodes or spleen are larger than normal, or enlarged.

Rai staging system
StageFeatures

0

There are too many lymphocytes.

The numbers of red blood cells and platelets are normal.

The lymph nodes and spleen are not enlarged.

I

There are too many lymphocytes.

The numbers of red blood cells and platelets are normal.

The lymph nodes are enlarged, but the spleen is not.

II

There are too many lymphocytes.

The numbers of red blood cells and platelets are normal.

The lymph nodes may be enlarged. The spleen is enlarged.

III

There are too many lymphocytes and too few red blood cells.

The number of platelets is normal.

The lymph nodes or spleen may be enlarged.

IV

There are too many lymphocytes and too few platelets.

The number of red blood cells may be low.

The lymph nodes or spleen may be enlarged.

Modified Rai staging system

The modified Rai staging system separates the levels into 3 risk groups.

  • Low-risk CLL is stage 0.
  • Intermediate-risk CLL includes stages I and II.
  • High-risk CLL includes stages III and IV.

Binet staging system

The Binet staging system has 3 levels. The levels are based on the number of red blood cells and the number of platelets in the blood and the number of areas of lymphatic tissue that are enlarged. The areas of lymphatic tissue are the spleen, liver and lymph nodes in the neck, underarm areas and groin.

Binet staging system
Binet stageRisk groupRai stagesFeatures

A

Low

0, I and II

The numbers of red blood cells and platelets are normal.

Fewer than 3 areas of lymphatic tissue are enlarged.

B

Intermediate

0, I and II

The numbers of red blood cells and platelets are normal.

Three or more lymphatic tissue areas are enlarged.

C

High

III and IV

The numbers of red blood cells and/or platelets are low.

Any number of lymphatic tissue areas are enlarged.

Relapsed

Relapsed, or recurrent, CLL means the leukemia has come back after treatment and reaching remission. Remission is usually defined as a decrease in or the disappearance of signs and symptoms and improved blood cell counts. If the CLL relapses, doctors may stage it again. This is called re-staging.

Refractory

Refractory disease means the leukemia did not respond to treatment.

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