How Has the Staging of CLL Changed?

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What are the stages of CLL? How have they changed? Dr. William Wierda, a world-renowned CLL expert from MD Anderson Cancer Center in Houston, describes the stages of CLL and how the stage of disease can be changed by treatment.

 

The Ask the Expert series is sponsored through an educational grant to the Patient Empowerment Network from Pharmacyclics, Inc.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Jeff Folloder:

We've got a lot of questions lined up. Let's start off with an important one. How has the staging of CLL changed? How do physicians go about approaching the staging correctly?

Dr. Wierda:

So staging really hasn't changed recently. We've been using the Rai criteria for many, many years.  The first paper I believe dates back into the ‘70s for the Rai staging system.  t's been modified over the years into a consolidated or condensed version, which is referred to as the modified Rai criteria. It basically reflects the extent of disease. So, for example, the earlier stage the patient is the less disease or lower bulk of disease that they have. So I can quickly go through the stages.

There's stage 0, which is just an elevated lymphocyte count. Stage I are patients who have enlarged lymph nodes. Stage II is enlarged liver or spleen. Stage III is a low hemoglobin, 11 or lower. And stage IV is a low platelet count of less than 100. And so the consolidated modified Rai staging is low risk, which is just the stage 0 patients, intermediate risk, which are the I and II by the old staging system, and then high-risk patients are patients who have stage III or IV disease.  And, again, it reflects the extent of involvement and extent of the disease in the body, and the prognosis is correlated with that, which those with that parameter.  So patients who have early-stage disease have a better survival, better long-term survival that patients who have extensive or advanced-stage disease.

Now the staging can change with treatment. So, for example, you can have a patient who has stage IV disease who gets treatment and goes into complete remission, and then they are—when they're in complete remission and they don't have any measurable disease then you can't stage them. But if they develop elevated lymphocyte count when the disease returns, at that point you can begin to restage them, and they typically will begin at stage 0 and then progress in the absence of additional treatment.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on July 9, 2014