Chronic lymphocytic leukemia clinical staging
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Haytham Allaham, M.D. [2]
Overview
According to the Rai Staging System, there are five stages of chronic lymphocytic leukemia based on the degree of lymphocytosis, hemoglobin level, platelet level, presence of splenomegaly, and presence of lymphadenopathy. According to the Binet Staging System, there are three stages of chronic lymphocytic leukemia based on the degree of lymphocytosis, the presence of anemia or thrombocytopenia, and the involvement of three or more lymphoid regions. The tumor stage is considered one of the important factors that determine the optimal management protocol of chronic lymphocytic leukemia patients.
Staging System
Rai Staging System:
According to the Rai Staging System, there are five stages of chronic lymphocytic leukemia based on the degree of lymphocytosis, hemoglobin level, platelets level, presence of splenomegaly, and presence of lymphadenopathy.[1][2][3][4]
| Stage | Hemoglobin Level | Platelets Level | Lymphocytosis | Splenomegaly | Lymphadenopathy | Median Survival |
|---|---|---|---|---|---|---|
|
Stage 0 |
>11 g/dL |
>100,000/L |
Present |
Absent |
Absent |
>150 months |
|
Stage 1 |
>11 g/dL |
>100,000/L |
Present |
Absent |
Present |
101 months |
|
Stage 2 |
>11 g/dL |
>100,000/L |
Present |
Present |
Present or absent |
71 months |
|
Stage 3 |
<11 g/dL |
>100,000/L |
Present |
Present or absent |
Present or absent |
19 months |
|
Stage 4 |
<11 g/dL or >11g/dL |
<100,000/L |
Present |
Present or absent |
Present or absent |
19 months |
The staging is further modified into 3 groups:[5]
- Low Risk: Stage 0
- Intermediate Risk: Stages 1 and 2 combined
- High Risk: Stage 3 and 4 combined
Binet Staging System
According to the Binet Staging System, there are three stages of chronic lymphocytic leukemia based on the degree of lymphocytosis, the presence of anemia or thrombocytopenia, and the involvement of three or more lymphoid regions: cervical, axillary and inguinal lymph nodes, and spleen and liver.[6][7][8][9]
| Stage | Lymphocytosis | Anemia or Thrombocytopenia | Lymphadenopathy | Median Survival |
|---|---|---|---|---|
|
Stage A |
Present |
Absent |
2 or less lymphoid regions |
Almost normal age and sex adjusted survival rate |
|
Stage B |
Present |
Absent |
>3 lymphoid regions |
7 years |
|
Stage C |
Present |
Present |
>3 lymphoid regions |
2 years |
References
- ↑ Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS (August 1975). "Clinical staging of chronic lymphocytic leukemia". Blood. 46 (2): 219–34. PMID 1139039.
- ↑ MacDougall BK, Weinerman BH (1988). "Staging and prognosis of chronic lymphocytic leukemia: the Manitoba experience". J Gen Intern Med. 3 (2): 139–43. PMID 3357070.
- ↑ Zwiebel JA, Cheson BD (February 1998). "Chronic lymphocytic leukemia: staging and prognostic factors". Semin. Oncol. 25 (1): 42–59. PMID 9482526.
- ↑ Hallek M (September 2017). "Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment". Am. J. Hematol. 92 (9): 946–965. doi:10.1002/ajh.24826. PMID 28782884.
- ↑ Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating MJ, Montserrat E, Rai KR, Kipps TJ (June 2008). "Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines". Blood. 111 (12): 5446–56. doi:10.1182/blood-2007-06-093906. PMC 2972576. PMID 18216293.
- ↑ Binet JL, Auquier A, Dighiero G, Chastang C, Piguet H, Goasguen J, Vaugier G, Potron G, Colona P, Oberling F, Thomas M, Tchernia G, Jacquillat C, Boivin P, Lesty C, Duault MT, Monconduit M, Belabbes S, Gremy F (July 1981). "A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis". Cancer. 48 (1): 198–206. PMID 7237385.
- ↑ MacDougall BK, Weinerman BH (1988). "Staging and prognosis of chronic lymphocytic leukemia: the Manitoba experience". J Gen Intern Med. 3 (2): 139–43. PMID 3357070.
- ↑ Zwiebel JA, Cheson BD (February 1998). "Chronic lymphocytic leukemia: staging and prognostic factors". Semin. Oncol. 25 (1): 42–59. PMID 9482526.
- ↑ Hallek M (September 2017). "Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment". Am. J. Hematol. 92 (9): 946–965. doi:10.1002/ajh.24826. PMID 28782884.