Diagnosis & Staging
I’ve received a CLL diagnosis. What’s next?
Once you’ve completed diagnostic testing, your doctor will review the results with you. If your doctor confirms a diagnosis of leukemia, additional tests may be used to learn more about the leukemia to determine the stage of cancer and help determine the best treatment plan for you. Cancer staging can be complex, so ask your doctor to explain it to you in detail since it can help determine which treatment is best and can help predict prognosis. Be sure to ask questions if there’s anything you don’t understand.
Rai Staging System
The Rai staging system is used to classify CLL across 5 stages ranging from stage 0 to stage 4, and can be used to determine when to start treatment. The Rai staging system categorizes leukemia based on whether the patient has any of the following:
- Lymphocytosis: High levels of lymphocytes in the blood
- Lymphadenopathy: Enlarged lymph nodes
- Splenomegaly: Enlarged spleen
- Anemia: Low levels of red blood cells (RBCs)
- Thrombocytopenia: Low levels of platelets
- Hepatomegaly: Enlarged liver
Rai Stage Grouping
- Stage 0: The patient has lymphocytosis with more than 5000 lymphocytes per microliter of blood, but no other physical signs. (>5,000 lymphocytes/ µL)
- Stage I: The patient has lymphocytosis and enlarged lymph nodes. The patient does not have an enlarged liver or spleen, anemia, or low levels of platelets.
- Stage II: The patient has lymphocytosis and an enlarged spleen and/or liver and may or may not have swollen lymph nodes.
- Stage III: The patient has lymphocytosis and anemia. The patient may or may not have swollen lymph nodes and an enlarged liver or spleen.
- Stage IV: The patient has lymphocytosis and low levels of platelets. The patient may or may not have swollen lymph nodes, an enlarged liver or spleen, or anemia.
Stages of CLL may be further classified into risk groups and may be used to indicate the likelihood that the disease may progress and require treatment.
Rai Stage Grouping and Risk Group Summary
Rai Stage |
High Lymphocyte Levels(Lymphocytosis) |
Enlarged Lumph Nodes(Lymphadenopathy) |
Enlarged Spleen or Liver(Splenomegaly/ Hepatomegaly) |
Low RBC Levels(Anemia) |
Low Platelet Levels(Thrombocytopenia) |
Risk Group |
|---|---|---|---|---|---|---|
| 0 |
|
|
|
|
|
Low Risk |
| I |
|
|
|
|
|
Intermediate Risk |
| II |
|
or |
|
|
|
Intermediate Risk |
| III |
|
or |
or |
|
|
High Risk |
| IV |
|
or |
or |
or |
|
High Risk |
Binet Classification
In Europe, doctors use a different staging system that’s based on whether CLL can be found in lymph nodes in the neck, underarms or groin AND whether the patient has low red blood cell or platelet levels.
Stage |
Lymph Nodes |
Low RBC Levels(Anemia) |
Low Platelet Levels(Thrombocytopenia) |
Rai Stages |
|---|---|---|---|---|
| A | < 3 | N | N | 0, I, II |
| B | ≥ 3 | N | N | I, II |
| C | Any number | Y | Y | III, IV |
