Assessment Of Extent Of Disease

Clinical staging continues to remain a readily available method of assessing the extent of disease in a patient with CLL. The five-part Rai system, or its three-part modification (Table 24.1), and the Binet system (Table 24.2) are being used both in the clinic as well as in clinical investigations.3

In the Binet system, there are five areas of lymphoid enlargement identified in a focused physical examination: (1) cervical; (2) axillary; (3) inguino-femoral (whether unilateral or bilateral on each site is counted as one site); (4) spleen; and (5) liver. In both systems, no additional weight is given to large, bulky tumor sizes of the palpable organs. However, the disease is considered to be active and progressive if the size of any palpable mass rapidly increases, and that becomes an appropriate reason to consider initiating cytotoxic therapy. Worsening of clinical stage, from the low-risk to the intermediate- or high-risk category is evidence, also, of disease progression and initiation of therapy.

Both the Binet and Rai staging systems were formulated before computerized axial tomography (CAT) scanning had become routine, and when enlargement of lymph nodes, spleen, or liver were recognized, they became clinically palpable.1 To this day, for assignment of stage of a disease, only findings upon a physical

Rai Staging System in CLL

Risk-Category (Modified Rai)

Clinical Stage

Criteria

Median Survival (Months)

Low Risk

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