Leukemia

Staging

Because leukemia starts in the bone marrow and often has spread to other organs by the time it is detected, there is no need for traditional staging. All leukemias are classified according to their genotypes, or their unique chromosomal arrangements, which also enables the physicians to determine risk factors.

Acute leukemia is classified in the French- American- British (FAB) system based upon the microscopic appearance of leukemia cells. According to FAB classification, acute leukemia is divided into eight subtypes of acute myelogenous leukemia (AML) and three subtypes of acute lymphocytic leukemia (ALL).

Chronic lymphocytic leukemia (CLL) is classified by 2 different staging systems, known as RAI Classification and Binet Staging, both based on the parts of the body affected by the leukemia.

The main features of Rai Classification stage of the chronic lymphocytic leukemia are :

• Stage 0 - This stage have high lymphocytes (a type of WBC) count in the blood, but there are no other symptoms of leukemia. It is a slow-growing stage and patients are at low risk.
• Stage 1 - Lymph nodes are larger than normal because of high lymphocytes count. Patients are at intermediate risk
• Stage 2 - Lymph nodes, liver and spleen are larger than normal as a result of an overabundance of lymphocytes. Patients are at intermediate risk
• Stage 3 - Anemia has developed because there are too few red blood cells in the blood. Lymph nodes, spleen and liver may be swollen because of high lymphocytes count. Patients are at high risk
• Stage 4 - There are too few platelets in the blood. Lymph nodes, spleen and liver may be swollen. Anemia may be present.

Binet staging system classifies CLL according to which lymphoid tissues, such as the spleen or lymph nodes, are involved as well as the presence of low red blood cell count (anemia) or low number of blood platelets (thrombocytopenia). The major advantage of the Binet system is its ability to highlight the splenic form of CLL.

The stage of binet system are :

• Stage A - There are three or fewer areas of enlarged lymph tissue. Lymph nodes in one particular area, such as the neck or underarm, are considered one group, whether they occur on just one side of the body (unilateral) or on both sides (bilateral).
• Stage B - There are more than three areas of enlarged lymph tissue.
• Stage C - Enlarged lymph tissue is present along with anemia and thrombocytopenia.

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