Chronic lymphocytic leukemia clinical staging: Difference between revisions
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{{Chronic lymphocytic leukemia}} | {{Chronic lymphocytic leukemia}} | ||
{{CMG}}; {{AE}} {{RT}} | |||
== Overview == | |||
== Classification == | |||
== | === Clinical staging === | ||
Staging is done with the Rai staging system and the Binet classification (see details<ref name="NCI-CLL-page2">{{cite web |url=http://www.cancer.gov/cancertopics/pdq/treatment/CLL/HealthProfessional/page2 |title=Chronic Lymphocytic Leukemia (PDQ®) Treatment: Stage Information |author=National Cancer Institute |accessdate=2007-09-04 |format= |work=}}</ref>). | Staging is done with the Rai staging system and the Binet classification (see details<ref name="NCI-CLL-page2">{{cite web |url=http://www.cancer.gov/cancertopics/pdq/treatment/CLL/HealthProfessional/page2 |title=Chronic Lymphocytic Leukemia (PDQ®) Treatment: Stage Information |author=National Cancer Institute |accessdate=2007-09-04 |format= |work=}}</ref>). | ||
==== | ==== Rai staging system ==== | ||
{|style="width:80%; height:110px" border="1" | {| style="width:80%; height:110px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Stage 0''' | | style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Stage 0''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Absolute lymphocytosis (>15,000/mm3) without adenopathy, hepatosplenomegaly, anemia, or thrombocytopenia. | | style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | Absolute lymphocytosis (>15,000/mm3) without adenopathy, hepatosplenomegaly, anemia, or thrombocytopenia. | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Stage 1''' | | '''Stage 1''' | ||
|bgcolor="Beige"| Absolute lymphocytosis with lymphadenopathy without hepatosplenomegaly, anemia, or thrombocytopenia. | | bgcolor="Beige"| Absolute lymphocytosis with lymphadenopathy without hepatosplenomegaly, anemia, or thrombocytopenia. | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Stage 2''' | | '''Stage 2''' | ||
|bgcolor="Beige"| Absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy. | | bgcolor="Beige"| Absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy. | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Stage 3''' | | '''Stage 3''' | ||
|bgcolor="Beige"| Absolute lymphocytosis and anemia (hemoglobin <11 g/dL) with or without lymphadenopathy, hepatomegaly, or splenomegaly. | | bgcolor="Beige"| Absolute lymphocytosis and anemia (hemoglobin <11 g/dL) with or without lymphadenopathy, hepatomegaly, or splenomegaly. | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Stage 4''' | | '''Stage 4''' | ||
|bgcolor="Beige"| Absolute lymphocytosis and thrombocytopenia (<100,000/mm3) with or without lymphadenopathy, hepatomegaly, splenomegaly, or anemia. | | bgcolor="Beige"| Absolute lymphocytosis and thrombocytopenia (<100,000/mm3) with or without lymphadenopathy, hepatomegaly, splenomegaly, or anemia. | ||
|- | |- | ||
|} | |} | ||
==== | ==== Binet Classification ==== | ||
{|style="width:80%; height:100px" border="1" | {| style="width:80%; height:100px" border="1" | ||
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Clinical stage A''' | | style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Clinical stage A''' | ||
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No anemia or thrombocytopenia and fewer than three areas of lymphoid involvement (Rai stages 0, I, and II). | | style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No anemia or thrombocytopenia and fewer than three areas of lymphoid involvement (Rai stages 0, I, and II). | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Clinical stage B''' | | '''Clinical stage B''' | ||
|bgcolor="Beige"| No anemia or thrombocytopenia with three or more areas of lymphoid involvement (Rai stages I and II). | | bgcolor="Beige"| No anemia or thrombocytopenia with three or more areas of lymphoid involvement (Rai stages I and II). | ||
|- | |- | ||
|-bgcolor="LightSteelBlue" | |- bgcolor="LightSteelBlue" | ||
| '''Clinical stage C''' | | '''Clinical stage C''' | ||
|bgcolor="Beige"| Anemia and/or thrombocytopenia regardless of the number of areas of lymphoid enlargement (Rai stages III and IV). | | bgcolor="Beige"| Anemia and/or thrombocytopenia regardless of the number of areas of lymphoid enlargement (Rai stages III and IV). | ||
|- | |- | ||
|} | |} | ||
The '''Binet classification''' integrates the number of nodal groups involved with the disease with bone marrow failure. Its major benefit derives from the recognition of a predominantly splenic form of the disease, which may have a better prognosis than in the '''Rai staging''', and from recognition that the presence of anemia or thrombocytopenia has a similar prognosis and does not merit a separate stage. Neither system separates immune from nonimmune causes of cytopenia. Patients with thrombocytopenia or anemia or both, which is caused by extensive marrow infiltration and impaired production (Rai III/IV, Binet C) have a poorer prognosis than patients with immune cytopenias.[4] The International Workshop on CLL has recommended integrating the Rai and Binet systems as follows: A(0), A(I), A(II); B(I), B(II); and C(III), C(IV). | The '''Binet classification''' integrates the number of nodal groups involved with the disease with bone marrow failure. Its major benefit derives from the recognition of a predominantly splenic form of the disease, which may have a better prognosis than in the '''Rai staging''', and from recognition that the presence of anemia or thrombocytopenia has a similar prognosis and does not merit a separate stage. Neither system separates immune from nonimmune causes of cytopenia. Patients with thrombocytopenia or anemia or both, which is caused by extensive marrow infiltration and impaired production (Rai III/IV, Binet C) have a poorer prognosis than patients with immune cytopenias.[4] The International Workshop on CLL has recommended integrating the Rai and Binet systems as follows: A(0), A(I), A(II); B(I), B(II); and C(III), C(IV). | ||
== References == | |||
==References== | |||
{{reflist|2}} | {{reflist|2}} | ||
{{Hematology}} | {{Hematology}} | ||
{{Hematological malignancy histology}} | {{Hematological malignancy histology}} | ||
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Revision as of 14:38, 23 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Raviteja Guddeti, M.B.B.S. [2]
Overview
Classification
Clinical staging
Staging is done with the Rai staging system and the Binet classification (see details[1]).
Rai staging system
Stage 0 | Absolute lymphocytosis (>15,000/mm3) without adenopathy, hepatosplenomegaly, anemia, or thrombocytopenia. |
Stage 1 | Absolute lymphocytosis with lymphadenopathy without hepatosplenomegaly, anemia, or thrombocytopenia. |
Stage 2 | Absolute lymphocytosis with either hepatomegaly or splenomegaly with or without lymphadenopathy. |
Stage 3 | Absolute lymphocytosis and anemia (hemoglobin <11 g/dL) with or without lymphadenopathy, hepatomegaly, or splenomegaly. |
Stage 4 | Absolute lymphocytosis and thrombocytopenia (<100,000/mm3) with or without lymphadenopathy, hepatomegaly, splenomegaly, or anemia. |
Binet Classification
Clinical stage A | No anemia or thrombocytopenia and fewer than three areas of lymphoid involvement (Rai stages 0, I, and II). |
Clinical stage B | No anemia or thrombocytopenia with three or more areas of lymphoid involvement (Rai stages I and II). |
Clinical stage C | Anemia and/or thrombocytopenia regardless of the number of areas of lymphoid enlargement (Rai stages III and IV). |
The Binet classification integrates the number of nodal groups involved with the disease with bone marrow failure. Its major benefit derives from the recognition of a predominantly splenic form of the disease, which may have a better prognosis than in the Rai staging, and from recognition that the presence of anemia or thrombocytopenia has a similar prognosis and does not merit a separate stage. Neither system separates immune from nonimmune causes of cytopenia. Patients with thrombocytopenia or anemia or both, which is caused by extensive marrow infiltration and impaired production (Rai III/IV, Binet C) have a poorer prognosis than patients with immune cytopenias.[4] The International Workshop on CLL has recommended integrating the Rai and Binet systems as follows: A(0), A(I), A(II); B(I), B(II); and C(III), C(IV).
References
- ↑ National Cancer Institute. "Chronic Lymphocytic Leukemia (PDQ®) Treatment: Stage Information". Retrieved 2007-09-04.