Chronic lymphocytic leukemia clinical staging: Difference between revisions
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{{Chronic lymphocytic leukemia}} | {{Chronic lymphocytic leukemia}} | ||
{{CMG}} {{AE}}{{HL}} | |||
==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, [[platelet]]s level, presence of [[splenomegaly]], and presence of [[lymphadenopathy]].<ref name="pmid11390392">{{cite journal |vauthors=Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN, Pasternack BS |title=Clinical staging of chronic lymphocytic leukemia |journal=Blood |volume=46 |issue=2 |pages=219–34 |date=August 1975 |pmid=1139039 |doi= |url=}}</ref><ref name="pmid3357070">{{cite journal |vauthors=MacDougall BK, Weinerman BH |title=Staging and prognosis of chronic lymphocytic leukemia: the Manitoba experience |journal=J Gen Intern Med |volume=3 |issue=2 |pages=139–43 |date=1988 |pmid=3357070 |doi= |url=}}</ref><ref name="pmid9482526">{{cite journal |vauthors=Zwiebel JA, Cheson BD |title=Chronic lymphocytic leukemia: staging and prognostic factors |journal=Semin. Oncol. |volume=25 |issue=1 |pages=42–59 |date=February 1998 |pmid=9482526 |doi= |url=}}</ref><ref name="pmid28782884">{{cite journal |vauthors=Hallek M |title=Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment |journal=Am. J. Hematol. |volume=92 |issue=9 |pages=946–965 |date=September 2017 |pmid=28782884 |doi=10.1002/ajh.24826 |url=}}</ref> | |||
== | {| style="border: 0px; font-size: 90%; margin: 3px; width: 1050px" | ||
| valign="top" | | |||
|+ | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Stage'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Hemoglobin Level'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Platelets Level'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Lymphocytosis'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Splenomegaly'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Lymphadenopathy'''}} | |||
! style="background: #4479BA; width: 300px;" | {{fontcolor|#FFF|'''Median Survival'''}} | |||
|- | |||
# ''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
'''Stage 0''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>11 g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>100,000/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>150 months | |||
|- | |- | ||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
| | '''Stage 1''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>11 g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>100,000/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
101 months | |||
|- | |- | ||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
| | '''Stage 2''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>11 g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>100,000/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present or absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
71 months | |||
|- | |- | ||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
| | '''Stage 3''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''<11''' g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>100,000/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present or absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present or absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
19 months | |||
|- | |- | ||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
| | '''Stage 4''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
<11 g/dL '''or''' >11g/dL | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''<100,000'''/L | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
'''Present''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present or absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present or absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
19 months | |||
|} | |||
The staging is further modified into 3 groups:<ref name="pmid18216293">{{cite journal |vauthors=Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H, Hillmen P, Keating MJ, Montserrat E, Rai KR, Kipps TJ |title=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 |journal=Blood |volume=111 |issue=12 |pages=5446–56 |date=June 2008 |pmid=18216293 |pmc=2972576 |doi=10.1182/blood-2007-06-093906 |url=}}</ref> | |||
* '''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.<ref name="pmid7237385">{{cite journal |vauthors=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 |title=A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis |journal=Cancer |volume=48 |issue=1 |pages=198–206 |date=July 1981 |pmid=7237385 |doi= |url=}}</ref><ref name="pmid33570702">{{cite journal |vauthors=MacDougall BK, Weinerman BH |title=Staging and prognosis of chronic lymphocytic leukemia: the Manitoba experience |journal=J Gen Intern Med |volume=3 |issue=2 |pages=139–43 |date=1988 |pmid=3357070 |doi= |url=}}</ref><ref name="pmid94825262">{{cite journal |vauthors=Zwiebel JA, Cheson BD |title=Chronic lymphocytic leukemia: staging and prognostic factors |journal=Semin. Oncol. |volume=25 |issue=1 |pages=42–59 |date=February 1998 |pmid=9482526 |doi= |url=}}</ref><ref name="pmid287828842">{{cite journal |vauthors=Hallek M |title=Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment |journal=Am. J. Hematol. |volume=92 |issue=9 |pages=946–965 |date=September 2017 |pmid=28782884 |doi=10.1002/ajh.24826 |url=}}</ref> | |||
{| style="border: 0px; font-size: 90%; margin: 3px; width: 1050px" | |||
| valign="top" | | |||
|+ | |||
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|'''Stage'''}} | |||
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|'''Lymphocytosis'''}} | |||
! style="background: #4479BA; width: 500px;" | {{fontcolor|#FFF|'''Anemia or Thrombocytopenia'''}} | |||
! style="background: #4479BA; width: 250px;" | {{fontcolor|#FFF|'''Lymphadenopathy'''}} | |||
! style="background: #4479BA; width: 700px;" | {{fontcolor|#FFF|'''Median Survival'''}} | |||
|- | |- | ||
= | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | ||
'''Stage A''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
2 or less lymphoid regions | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Almost normal age and sex adjusted survival rate | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
'''Stage B''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Absent | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>3 lymphoid regions | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
7 years | |||
|- | |||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" align="center" | | |||
'''Stage C''' | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
Present | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
>3 lymphoid regions | |||
| style="padding: 5px 5px; background: #F5F5F5;" align="center" | | |||
2 years | |||
|} | |||
==References== | == References == | ||
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Latest revision as of 15:54, 28 February 2019
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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.