CLL Staging

CLL is staged according to one of two distinct systems—Rai and Binet1,2

  • Both classification systems rely solely on a physical examination and standard laboratory tests and do not require imaging

Modified Rai staging1-3

Rai staging defines disease into low risk (formerly Rai Stage 0), intermediate risk (formerly Rai Stage I or II), and high risk (formerly Rai Stage III or IV):

Modified Rai Stage1,3 Clinical Outcomes1,3 Risk1,3 Median OS (months)3,4
0

Lymphocytosis with leukemia cells in blood and bone marrow only

Low

>150
(12.5 years)

I–II

Lymphocytosis, lymphadenopathy, splenomegaly, and/or hepatomegaly

Intermediate 71-101
(5.9–8.4 years)
III–IV

Disease-related anemia or thrombocytopenia

High 19
(1.6 years)
Modified Rai Stage1,3 0
Clinical Outcomes1,3

Lymphocytosis with leukemia cells in blood and bone marrow only

Risk1,3 Low
Median OS (months)3,4 >150 (12.5 years)
Modified Rai Stage1,3 I–II
Clinical Outcomes1,3

Lymphocytosis, lymphadenopathy, splenomegaly, and/or hepatomegaly

Risk1,3 Intermediate
Median OS (months)3,4 71-101 (5.9–8.4 years)
Modified Rai Stage1,3 III–IV
Clinical Outcomes1,3

Disease-related anemia or thrombocytopenia

Risk1,3 High
Median OS (months)3,4 19 (1.6 years)

Binet staging1,4

Binet staging is based on the number of areas* with enlarged lymph nodes or organomegaly, and whether patients have anemia and/or thrombocytopenia.

  • Stage A (low risk) is defined as Hb level ≥10 g/dL, platelets ≥100 x 109/L and ≤2 lymphoid areas involved
  • Stage B (intermediate risk) is defined as Hb level ≥10 g/dL, platelets ≥100 x 109/L, and ≥3 lymphoid areas involved
  • Stage C (high risk) is defined as Hb level <10 g/dL and/or platelet count <100 x 109/L
Binet Stage1,4 Clinical Outcomes1,4 Risk1,3 Median OS (months)3,4
Stage A

Hemoglobin ≥10 g/dL; Platelets ≥100 x 109/L

  • ≤2 involved areas
Low Comparable to
age-matched controls
Stage B

Hemoglobin ≥10 g/dL; Platelets ≥100 x 109/L

  • Organomegaly ≥3 areas of nodal or organ enlargement
Intermediate 84
(7.0 years)
Stage C

Hemoglobin <10 g/dL and/or Platelets <100 x 109/L

  • Irrespective of organomegaly
High 24
(2.0 years)
Binet Stage1,4 Stage A
Clinical Outcomes1,4

Hemoglobin ≥10 g/dL; Platelets ≥100 x 109/L

  • ≤2 involved areas
Risk1,3 Low
Median OS (months)3,4 Comparable to age-matched controls
Binet Stage1,4 Stage B
Clinical Outcomes1,4

Hemoglobin ≥10 g/dL; Platelets ≥100 x 109/L

  • Organomegaly ≥3 areas of nodal or organ enlargement
Risk1,3 Intermediate
Median OS (months)3,4 84 (7.0 years)
Binet Stage1,4 Stage C
Clinical Outcomes1,4

Hemoglobin <10 g/dL and/or Platelets <100 x 109/L

  • Irrespective of organomegaly
Risk1,3 High
Median OS (months)3,4 24 (2.0 years)

*The areas of involvement considered for Binet staging are (1) head and neck, including the Waldeyer ring (this counts as one area, even if one or more groups of nodes are enlarged); (2) axillae (involvement of both axillae counts as one area); (3) groins, including superficial femoral (involvement of both groins counts as one area); (4) palpable spleen; and (5) palpable liver (clinically enlarged).1,4

CLL=chronic lymphocytic leukemia, Hb=hemoglobin, OS=overall survival.

When to initiate treatment

CLL may be minimally symptomatic at presentation. When should treatment begin?

View recommendations

References: 1. Hallek M, Cheson BD, Catovsky D, et al. iwCLL guidelines for diagnosis, indications for treatment, response assessment, and supportive management of CLL. Blood. 2018;131(25):2745-2760. 2. Hallek M. Chronic lymphocytic leukemia: 2017 update on diagnosis, risk stratification, and treatment. Am J Hematol. 2017;92(9):946-965. 3. Rai K, Sawitsky A., Cronkite E, et al. Clinical staging of chronic lymphocytic leukemia. Blood. 1975;46(2):219-234. 4. Binet JL, Auquier A, Dighiero G, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer. 1981;48(1):198-206.

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