What are the stages of chronic lymphocytic leukemia?

So in the United States, the Rai staging system is what we use to stage
chronic lymphocytic leukemia. There's Rai stage 0, I, II, III, IV. Rai stage 0 is when you have  excess of the lymphocytes but you don't have any other problems
that you can discern In Rai stage I, you do have lymph gland swelling. Rai stage II, you do have spleen and a liver enlargement In Rai stage III, you're going to get to be anemic and dry. In Rai stage IV, your platelets go down as well A lot of times patients will ask me, oh, do I have metastases? No, it's different because the disease is always everywhere. So it's a little bit different than staging other cancers. But staging is still important because staging guides us on what we're going to do. So going back to the example, the breast cancer, sometimes stage one breast cancer, you might just do surgery station, you may do surgery and some radiation— so staging guides us
and not necessarily means where it is, but are ways to define the extent of the disease or the burden of the disease. So we do have staging in CLL,
and this staging mainly takes into consideration if you have lymph nodes enlarged, if you have your spleen enlarged, or if you have a little bit more involvement of the disease causing problems in your bone marrow with low hemoglobin, low platelets. So the staging can guide us on what to expect from the disease. But more than the staging today, what we really use are genetic features. There are molecular changes, that are mutations, that are specific findings that guide us on how we expect the disease to behave. So in the end, all of these give us information of what to expect. But most of them are not really indication for treatment. We still define if we're going to treat or not based on the presence of the symptoms, those features that tell us the disease is causing trouble. That's usually how I tell you: if diseases causing trouble would take care of it. If it's not causing trouble, just sitting there won't do anything and the staging may guide us on what to expect, but is very different than the staging that we have for the other cancers because the disease already starts off being in your blood. For chronic lymphocytic leukemia, we generally, [...] often don't even need to treat patients, and observation alone may be possible for a period of time. The reason to treat would be if you start developing Rai stage II or greater disease and have got an enlarged spleen, enlarged liver, or if your hemoglobin and platelet count declines. Also, if you're under a wait and watch approach, if your white count is doubling in less than six months, that would be a reason to treat. Patients who are symptomatic  with fevers, night sweats, weight loss or any other symptoms would also be worthy of considering treatment. The staging system is prognostic, so patients who have higher rate stages do have a shorter time to progression and they do have a more limited lifespan. So the stages in CLL, this basic staging, will tell us a little bit about risk. So patients that present with more advanced stage means that they have a greater burden of disease. Probably they will require therapy faster or they require therapy right away and they may have problems earlier on. So stages do have a relationship with that. But what really [...] guides us beyond the staging are really these genetic molecular markers. So there are two big categories. One is: It's called immunoglobulin heavy gene —whether it's mutated or not. So the immunoglobulin heavy gene is a way that we know how mature or immature this cell is. And the idea is if it's a very immature cell, it tends to be a little bit of a more aggressive disease. So we use that to, kind of, guide us  on what to expect from therapy. And then there are specific gene mutations or changes And then there are specific gene mutations or changes in chromosomes, like deletions in  certain parts of chromosomes or mutations in certain genes. So deletion of the of the small arm of chromosome 17. So, 17p deletion or the mutation on the gene TP53. So those are some of important mutations that guide us on what to expect from the disease. So those are some of important mutations that guide us on what to expect from the disease. At the moment, the most commonly used risk stratification system does not include the genetic information, but we know it is prognostic and in the future it will probably be part of some new classification system for prognosis that will be adopted.