Part of the diagnosis process of chronic lymphocytic leukemia (CLL) includes a staging diagnosis to determine the progression of the cancer and the treatment needed. This is done using a variety of tests such as checking for body swelling of lymph system organs, blood tests, imaging, and sometimes bone marrow tests. Your doctor will use either one or a combination of the following staging systems to determine this. The staging systems include the Rai system (most common in the United States) and the Binet system (more commonly used in Europe).

The Rai System

The Rai system is based on lymphocytosis. A high number of lymphocytes must be present in the blood and bone marrow that isn’t a result of any other infection. “For a diagnosis of CLL, the overall lymphocyte count does not have to be high, but the patient must have at least 5,000/mm monoclonal lymphocytes (sometimes called a monoclonal lymphocytosis). Monoclonal means that the cancer cells all came from one original cell. This causes them to have the same chemical pattern which can be seen with special testing” (cancer.org).

• Rai Stage 0: Red blood cell and platelet counts are near normal. There is no enlargement of the spleen, liver, or lymph nodes. This is low-risk CLL. Your doctor may advise you to wait and watch for symptoms. You may not need treatment for several years
• Rai Stage I: Red blood cell and platelet counts are near normal. The lymph nodes are enlarged but the spleen and liver are normal sizes. This is intermediate-risk CLL. Treatment is usually recommended to begin right away
• Rai Stage II: Red blood cell and platelet counts are near normal. The spleen and/or liver are enlarged. Lymph nodes may or may not be enlarged. This is intermediate-risk CLL. Treatment is usually recommended to begin right away
• Rai Stage III: Red blood cell counts are low (anemia) and platelet counts are near normal. The spleen, liver, and lymph nodes may or may not be enlarged. This is high-risk CLL. Treatment should be immediate
• Rai Stage IV: Red blood cell count is low or near normal and platelet count is low (thrombocytopenia). The spleen, liver, and lymph nodes are enlarged. This is high-risk CLL. Treatment should be immediate

The Binet System

The Binet system classifies CLL based on the number of affected lymphoid tissue groups (neck, groin, underarm, spleen, liver). Anemia (low red blood cells) and thrombocytopenia (low platelet count) are also considered.

• Binet Stage A: fewer than 3 areas of lymphoid tissue are enlarged. Anemia and thrombocytopenia are not present
• Binet Stage B: 3 or more areas of lymphoid tissue are enlarged. Anemia and thrombocytopenia are not present
• Binet Stage C: any number of lymphoid tissues are enlarged. Anemia and/or thrombocytopenia are present

Be active in your CLL care. Once the disease progresses, there are several non-chemo treatment options available that for many CLL patients, successfully help manage the cancer.