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Stages

Most of the cancer staging is done on the basis of the spread and size of tumors. But, for leukemia, the staging of blood cancer is characterized by cell count and the buildup of leukemia tissues in other organs such as spleen or liver.

That said, cancer stage is a crucial factor for the treatment of leukemia.

Following pointers impact the staging of leukemia:

Bone damage
Age
Chromosome mutations or abnormalities
WBCs or platelets count
History of prior blood disorders
Enlarged liver or spleen

When and how does my doctor determine the stage of my leukemia?

Doctors can use various methods of staging to evaluate the stage of leukemia. Along with symptoms, other test results and patient’s general health profile will also be taken into account for evaluation of leukemia stage.

Rather than using traditional methods, such as the TNM staging system, for leukemia staging, a doctor will first determine the subtype of the condition by evaluating the results of cytologic tests, flow cytometry or other lab tests.

Each leukemia subtype is then staged using a unique system:

Acute lymphocytic leukemia – Staging is based on the type of lymphocyte and the maturity of the cells
Acute myelogenous leukemia – Staging is done by using the French-American-British (FAB) system, which takes into account the number of healthy blood cells, the size and number of the leukemia cells, the changes in the chromosomes of the leukemia cells and other genetic abnormalities.
Chronic lymphocytic leukemia – Staging is done using the Rai system, which is based on three factors: i) number of lymphocytes in the blood ii) degree of the lymph node, spleen or liver enlargement iii) presence of anemia or thrombocytopenia.
Chronic myelogenous leukemia – Staging is based on the number of diseased cells found in blood and bone marrow tests.

Acute Lymphoblastic Leukemia (ALL)

What is acute lymphocytic leukemia (ALL)?

Acute lymphoblastic leukemia (ALL) is a blood cancer that affects the white blood cells. There are two main types of white blood cells, lymphocytes (affected by ALL) and myelocytes (affected by AML).

Lymphocytes are further broken down into B and T cell lymphocytes.

ALL is a spectrum of disease comprised of several different subtypes, named for the cell type that is affected (B or T) and how abnormal the cell appears under a microscope. A person with ALL develops abnormal numbers of white blood cells rather quickly, usually over weeks, giving the disease the name “acute.”

The white blood cell (WBC) count may be higher or lower than normal, but the WBCs that are being produced are immature and do not function well. Because WBCs are an important part of fighting infections, patients often have multiple infections that don’t respond to treatment before they are diagnosed. Some people will have the low red blood cell or platelet counts because the overpopulation of WBCs crowds out these cells.

What are the stages of acute lymphocytic leukemia (ALL)?

For ALL, staging is not done on the basis of tumor size because it begins from bone marrow. Normally, ALL spreads to other parts of the body prior to its detection and staging procedure will count other factors in addition to spread for staging.

Different stages of acute lymphocytic leukemia include:

Untreated ALL
ALL in remission. This means there’s no sign of leukemia after treatment
Minimal residual disease. This stage refers to presence of minute count of leukemia cells in bone marrow
Refractory ALL. During this stage the patient fails to respond to therapy
Recurrent ALL or Relapsed ALL refers to come back of the disease post treatment

B-cell ALL staging

B-lymphocytes or B cells are produced in the bone marrow, where they also mature. B-cells play a large role in humoral immune response and serve the principal functions of making antibodies against antigens and developing into memory B cells after they have been activated by antigen interaction.

T-cell ALL staging

T-lymphocytes or T cells are a specific type of leukemia which is similar to some types of lymphoma. These cells are aggressive and progress quickly. Also, these leave the bone marrow before maturation and move to the thymus, where they mature.

There are several different subsets of T cells that have distinct functions this includes Helper, Cytotoxic, Memory, Regulatory, Natural killer and Gamma Delta T cells.

B vs. T cells

Acute lymphoblastic leukemia (ALL) is a blood cancer which affects the lymphocytic cells, a type of white blood cell. People with ALL produce too many immature lymphoid cells, also called as blast cells which populate the blood and bone marrow, thereby, preventing it from producing healthy blood cells.

The WHO system divides ALL into several groups, which includes B-cells and T-cells. While B lymphocytes, or B cells, are a type of white blood cells that play a crucial role in protecting your body from infection by making antibodies against antigens, T-cells, on the other hand are vital in hosting an immune response against pathogens.

Similar treatment protocols are used for both B-ALL and T-ALL.

Acute Myeloid Leukemia (AML)

Acute myeloid leukemia can be differentiated in eight stages as follows:

Undifferentiated AML or M0: This stage has no major signs of differentiation in bone-marrow cells.
Myeloblastic leukemia or M1: In this stage some signs of granulocytic isolation with or without least cell maturation.
Myeloblastic leukemia or M2: This stage refers to bone marrow cells maturation beyond the promyelocyte stage.
Promyelocytic leukemia or M3: In this stage, anomalous cells are in developing stage with nucleuses of different shape and size.
Myelomonocytic leukemia or M4: This stage has variable amounts of differentiated granulocyte and monocytes in circulating blood and bone marrow.
Monocytic leukemia or M5: This stage has two categories: first stage is defined by inadequately differentiated monoblasts with genetic material, while second stage is defined by several monocytes, promonocytes and monoblasts.
Erythroleukemia or M6: In this stage blood cancer is defined by anomalous RBCs creating cells that count up to more than 50% of the nucleated cells inside the bone marrow.
Megakaryoblastic leukemia or M7: The stage refers to extensive fibrosis present in the bone marrow.

Stage 4 leukemia life expectancy

Some subtypes of AML tend to have a better outlook and expectancy than others.

What are the stages of acute myelogenous leukemia (AML)?

Because AML starts in the bone marrow and is usually not detected until it has spread to other organs, traditional cancer staging is not needed.

Rather than using the common TNM method for evaluating the cancer, the subtype of AML is classified using a cytologic (cellular) system.

Experts are not only able to predict how the cancer will respond to treatment based on the cellular classification, but are also able to accurately assess the prognosis.

Acute myeloid leukemia stages

There are two main systems that have been used to classify AML into subtypes:

French-American-British (FAB) classification
World Health Organization (WHO) classification

According to FAB classification, AML is divided into subtypes, M0 through M7. This is based on maturity of the cells and also the type of cell leukemia develops from.

Unlike the FAB classification system, the WHO classification system takes into account many of the factors that are now known to affect the prognosis (outlook) that can better classify AML.

AML subtypes and staging

Using a system known as French-American-British (FAB) classification, AML is classified into eight subtypes, M0 through M7, based on:

Number of healthy blood cells
Size and number of leukemia cells
Chromosomal changes in leukemia cells
Any other genetic abnormalities that have occurred.

Chronic Lymphocytic Leukemia (CLL)

What are the stages of chronic lymphocytic leukemia (CLL)?

Because CLL disease develops and spreads differently, its staging is different from staging for the kind of cancers that form tumors.

The Rai Staging System is based on blood cell counts, instead of rating the size and tumor spread.

The Binet System, on the other hand, summarizes the spread of cancer throughout the lymph nodes in three stages simply labeled A, B and C.

By identifying the stage of chronic lymphocytic leukemia, your doctor is able to choose when to begin treatment and determine which CLL treatments may be most effective for you.

Rai Staging System for CLL

Stages of chronic lymphocytic leukemia in the Rai System are based on three main factors:

the number of lymphocytes in the blood
whether the lymph nodes, spleen or liver are enlarged
whether the blood disorders anemia or thrombocytopenia (too few platelets) have developed.

In general, CLL begins as a condition called lymphocytosis, which is having too many lymphocytes.
Generally, a count of over 10,000 lymphocytes per sample is considered too high. It is the benchmark for stage 0.

The five stages are labeled with Roman numerals 0-IV:

Rai Stage 0 CLL: The levels of the lymphocytes during this stage are too high, more than 10,000 in one sample. There’s no other symptom developed at this point, and other blood cell counts are normal.
Rai Stage I CLL: In addition to the high levels of lymphocytes, the lymph nodes are swollen during this stage. The levels of red blood cells and platelets are still normal, though.
Rai Stage II CLL: Lymphocytes are high; also, the liver or spleen might be larger than normal.
Rai Stage III CLL: The excess number of lymphocytes begins to crowd out the RBCs. This results in anemia. Among other changes, the lymph nodes may be swollen, and the liver or spleen may be larger than normal.
Rai Stage IV CLL: The levels of RBCs and platelets drop below normal. This causes anemia and thrombocytopenia. Besides, the lymph nodes may be swollen, and the liver or spleen may be larger than normal.

To simplify it further, the Rai system of chronic lymphocytic leukemia staging is sometimes classified as:

low (stage 0), medium (stage I and II) and high (stage III and IV) risk categories.

This classification often helps doctors to determine when to start the treatment.

Binet Staging System

In this staging system, advanced stages of chronic lymphocytic leukemia are characterized by the presence of blood disorders that primarily result from few red blood cells and platelets. However, instead of relying on the counts from a blood test, the Binet System, which is also called as clinical stage, evaluates how many areas of lymphoid tissue are affected.

Clinical stage A: Lymph nodes may be swollen, but the cancer is limited to fewer than three areas.
Clinical stage B: More than three areas of lymphoid tissues are swollen.
Clinical stage C: Anemia and thrombocytopenia have developed.

Chronic Myeloid Leukemia stages

To stage CML, your oncologist or cancer specialist will examine blood and bone marrow tests to determine the number of diseased cells.

There are three stages of CML:

Chronic: This is the initial or the earliest phase of CML. Maximum number of CML patients are diagnosed during this phase as they experience mild symptoms, particularly fatigue.
Accelerated: If CML fails to respond to treatment well during the chronic phase, it becomes more aggressive, which then leads to the accelerated phase. At this point, symptoms may become more noticeable.
Blastic: This is by far the most aggressive stage of chronic myeloid leukemia. Blastic refers to having more than 20% myeloblasts or lymphoblasts. Symptoms experienced during this stage are similar to those of acute myeloid leukemia.

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