Chronic lymphocytic leukemia (CLL) is a type of slow-progressing blood cancer. It involves an overproduction of a type of white blood cell called lymphocytes. Medical tests can help determine the stage of the cancer, which measures how far the disease has progressed.
Doctors use one of two staging systems to help determine the CLL stage: the Rai staging system and the Binet staging system. Both systems can help guide treatment and determine individual outlooks.
This article describes both the Rai and Binet staging systems. It also highlights some factors that can affect a person’s outlook and lists some support networks available to people living with CLL.
According to the
The ACS outlines two types of staging system for CLL: Rai staging and Binet staging.
In the United States, medical professionals typically use the Rai staging system to classify CLL.
The Rai system has five stages, ranging from stage 0 to stage 4. According to Cancer Research UK, the Rai system considers levels of a type of white blood cell called lymphocytes.
The following are the different Rai stages, alongside a description of what happens at each stage.
- Stage 0: CLL causes lymphocytosis, which is an increase in the number of lymphocytes.
- Stage 1: The person has lymphocytosis and enlarged lymph nodes.
- Stage 2: The individual has lymphocytosis and enlargement of the liver or spleen. They may also have enlarged lymph nodes.
- Stage 3: The person has lymphocytosis and anemia, which is the medical term for low levels of red blood cells. They may also have an enlarged liver or spleen and enlarged lymph nodes.
- Stage 4: The individual has lymphocytosis and thrombocytopenia, which is the medical term for low platelets. They may also have an enlarged liver or spleen and enlarged lymph nodes.
The Leukemia & Lymphoma Society classifies the five Rai stages into the following three risk groups:
- Stage 0: Low risk
- Stages 1 and 2: Intermediate risk
- Stages 3 and 4: High risk
In Europe, medical professionals primarily use the Binet staging system to stage CLL. This system identifies three stages and considers the following:
- the person’s red blood cell count
- the person’s platelet count
- the location of swollen lymph nodes
Cancer Research UK explains that lymph nodes develop in the neck, spleen, liver, armpits, and groin. It adds that if swelling occurs in one type of lymph node on both sides of the body, doctors classify this as a single area. For example, if someone has swelling in the lymph nodes in each armpit, doctors would consider this a single area of lymph node enlargement.
The three Binet stages and their associated symptoms are as follows:
- Stage A: A person has fewer than three areas of enlarged lymphoid tissue.
- Stage B: A person has three or more areas of enlarged lymphoid tissue.
- Stage C: A person has anemia or thrombocytopenia and may experience the following symptoms:
- heavy periods
- repeated infections
- Age: CLL is
more commonamong middle-aged and older adults, and the prognosis tends to worsen with age. According to the United Kingdom’s National Health Service (NHS), people who receive a diagnosis of CLL at a young age typically have a more favorable prognosis.
- Beta-2-microglobulin (B2M) levels: B2M is a protein that cells produce in response to cancer. Small amounts of this protein in the blood or urine are typical. However, high levels can indicate CLL, other blood cancers, or lymphomas and
suggesta more negative prognosis.
- The proportion of prolymphocytes: Prolymphocytes are cells that have not yet fully developed into lymphocytes. A high proportion of prolymphocytes in the blood has links to a more negative prognosis.
- Lymphocyte doubling time: Producing double the number of lymphocytes in less than 1 year has associations with a more negative prognosis.
- Chromosome deletions: People who are missing parts of chromosome 17 or 11 may have a more negative prognosis.
Having CLL, in addition to another type of cancer, may also affect outlook. According to the
The ACS provides a Cancer Survivors Network forum for people living with cancer. Individuals can use the forum to post about their cancer journey and meet others with the same disease and symptoms.
People can also use the free online tool CaringBridge. This platform allows users to create a personalized web page where they can share their cancer journey with others. Users also have access to a CaringBridge planner that allows them to request and accept help for daily tasks and errands and schedule personal visits.
The following support groups and charities also offer information and resources for people living with CLL and other types of cancer:
CLL is a slow-progressing cancer that affects white blood cells called lymphocytes. When diagnosing CLL, medical professionals will conduct tests to determine the stage of the disease. Staging helps guide treatment and determine a person’s individual outlook.
There are two staging systems for CLL: the Rai system and the Binet system. Both systems take into account certain markers of disease progression, such as lymph node enlargement, anemia, and thrombocytopenia. Doctors in the U.S. typically use the Rai system, while those in Europe typically use the Binet system.
People living with CLL may benefit from joining a support group, such as the ACS’s Cancer Survivors Network. Individuals can also establish their own care and support network through the platform CaringBridge.