The staging, classification and prognosis of leukaemia

Staging

The tests undertaken to diagnose leukaemia help your specialist work out how far the cancer has spread. This is known as staging, and it helps your health care team recommend the best treatment for you.

AML

There is no standard staging system for AML.

The disease is described as:

• untreated,
• in remission
• recurrent.

ALL

Working out the subtype of acute lymphoblastic leukaemia (ALL) is called classification. It helps doctors to plan treatment and work out prognosis. ALL is divided into several subtypes according to the type of lymphocyte (B-cell or T-cell) that has become abnormal.

CML

is described in three phases:

• chronic – a few blast cells are found in the blood and bone marrow
• accelerated – after a few years the leukaemia may suddenly change and grow quicker
• blast – the number of blast cells increases, causing symptoms to worsen. Blast cells often spread to other organs.

CLL

There are two staging systems commonly used for CLL: the Binet system and the Rai system.

In Australia, most doctors use the Binet system.

The Rai system divides CLL into five stages and separates these stages into low-risk, intermediate-risk and high-risk groups. It is used mainly in the United States.

Binet staging system

Stage A – There are a high number of white blood cells but fewer than three enlarged areas of lymph tissue (lymph nodes, liver and/or spleen).

Stage B – There are a high number of white blood cells and three or more enlarged areas of lymph tissue.

Stage C – There are a high number of white blood cells with a low number of red blood cells (anaemia) and/or platelets (thrombocytopenia), and enlarged lymph nodes or spleen.

Prognosis

Prognosis means the expected outcome of a disease. You may wish to discuss your prognosis with your doctor, but it is not possible for any doctor to predict the exact course of the disease. Instead, your doctor can give you an idea about the general prognosis for people with the same type and stage of cancer.

To come up with a prognosis, your doctor will consider:

• test results
• the type of leukaemia you have
• the rate and extent of growth
• other factors such as age, fitness and medical history

These details will also help your doctor advise you on the best treatment options.