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Chronic Lymphocytic Leukemia

Overview of Stage System & Treatment Options of CLL

By March 2, 2022January 9th, 2024No Comments

Stage Information for Chronic Lymphocytic Leukemia: A staging system typically is a standard way for the cancer care specialist to describe cancer. There are basically two different systems for staging Chronic Lymphocytic Leukemia:

Rai System: more oftenly used in the United States.

Binet System: more widely used in Europe.

Both of these staging systems for Chronic Lymphocytic Leukemia are helpful and have been in use for so many years.

Rai Staging System

This more often used system in the United States is mainly based on lymphocytosis. The patient must have greater lymphocytes in their blood as well as bone marrow that isn’t associated with any other cause (like infection).

To diagnose Chronic Lymphocytic Leukemia, the overall lymphocyte count does not have to be greater, but the patient must have a minimum 5,000/mm3 monoclonal lymphocytes (monoclonal lymphocytosis). Monoclonal means that the malignant cells all came from a single original cell. This results in the same chemical pattern which can be noticed through special testing.

Rai staging system divides Chronic Lymphocytic Leukemia into 5 stages on the basis of results of blood tests and a physical exam:

Rai stage 0: Lymphocytosis; no enlargement of the lymph nodes, spleen, or liver; RBC and platelet counts are near normal.

Rai stage I: Lymphocytosis; enlarged lymph nodes; spleen and liver are not enlarged; RBC and platelet counts are near normal.

Rai stage II: Lymphocytosis; enlarged spleen (and maybe an enlarged liver); lymph nodes may or may not be enlarged; RBC and platelet counts are near normal.

Rai stage III: Lymphocytosis; lymph nodes, spleen, or liver may or may not be enlarged; RBC counts are decreased (anemia); platelet counts are near normal.

Rai stage IV: Lymphocytosis; enlarged lymph nodes, spleen, or liver; RBC counts may be decreased or near normal; platelet counts are decreased (thrombocytopenia).

Health specialists separate the Rai stages into low-, intermediate-, and high-risk groups when specifying treatment options.

  • Stage-0 is low risk.
  • Stages-I & II are intermediate risk.
  • Stages-III & IV are high risk.
Binet Staging System

In this staging system, chronic lymphocytic leukemia is classified by the number of affected lymphoid tissue groups ( groin lymph nodes, neck lymph nodes, underarm lymph nodes, spleen, and liver) and by whether or not the patient has too few red blood cells or too few blood platelets.

Binet stage-A: Fewer than three portions of lymphoid tissue are enlarged, with no anemia or thrombocytopenia.
Binet stage-B: Three or more portions of lymphoid tissue are enlarged, with no anemia or thrombocytopenia.
Binet stage-C: Existence of anemia and/or thrombocytopenia. Any number of lymphoid tissue portions may be enlarged.

Treatment Option Overview
There are different types of treatment options for patients with chronic lymphocytic leukemia. Following are the certain types of CLL treatments:

Watchful Waiting/Observation: Watchful waiting or observation is a process of closely monitoring a patient’s overall condition without giving any treatment until signs/symptoms appear or change. This process is used for treating asymptomatic and symptomatic or progressive chronic lymphocytic leukemia.
Targeted Therapy: Targeted therapy is a type of therapy that uses medicines or other substances in order to identify and attack specific malignant cells. Different sort of targeted therapy are used in order to treat CLL:

Tyrosine kinase inhibitor (TKI) therapy: In this, TKIs: ibrutinib, idelalisib, acalabrutinib, and duvelisib are used for treating symptomatic or progressive, recurrent, or refractory chronic lymphocytic leukemia.
BCL2 inhibitor therapy: In this therapy, Venetoclax is used, which is a type of BCL2 to treat symptomatic or progressive, recurrent, or refractory chronic lymphocytic leukemia. This drug is supplied in the form of tablets and in 100 mg dosage strength. The price of venetoclax 100 mg tablet in India is comparatively less than other countries. Individuals can connect to us (WHO-GDP & ISO certified pharmaceutical wholesaler/supplier) through TOLL-FREE: 1800-889-1064 to get this CLL medication. 
Monoclonal antibody therapy: In this therapy, certain drugs such as ofatumumab, rituximab, and obinutuzumab alone and together with chemotherapy are used for treating symptomatic or progressive, recurrent, or refractory chronic lymphocytic leukemia.

Chemotherapy: In chemotherapy, drugs are used to stop the progression of malignant cells, either by destroying the cells or by inhibiting their progression. When chemo is taken orally or injected into a vein or muscle, the drugs enter the bloodstream and can reach malignant cells throughout the body (systemic chemotherapy). Although, in combination chemo, more than one anticancer drug is used. 

Radiation therapy: In this therapy, doctors typically use high-energy x-rays or other sorts of radiation to destroy malignant cells or keep them from growing. The external radiation therapy uses a machine outside the body in order to send radiation toward the portion of the body with cancer, such as a group of spleen or lymph nodes. This therapy may be used for reducing pain related to a lymph node or swollen spleen. 

Immunotherapy: In this, doctors use the patient’s immune system in order to fight cancer. This cancer therapy  is a sort of biologic therapy.
Immunomodulating agent: Lenalidomide stimulates T-cells to destroy leukemia cells. It may be prescribed alone or with drug rituximab in patients with symptomatic or progressive, recurrent, or refractory chronic lymphocytic leukemia.
CAR T-cell therapy: This therapy changes the patient’s T-cells so they will attack certain proteins on the surface of malignant cells. 

Chemotherapy with bone marrow or peripheral stem cell transplant: Chemotherapy is recommended to destroy malignant cells. Healthy cells, including blood-forming cells, are killed by cancer treatment. The bone marrow or peripheral stem cell transplant are treatments for replacing the blood-forming cells. The stem cells or immature blood cells are eliminated from the bone marrow or blood of the patient or a donor and are frozen and stored. Following the patient finishes their chemo, the stored stem cells are thawed and given back to the patient with the help of an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.

COMBINATION THERAPY: In May 2019, the Food and Drug Administration (FDA) approved Combination Therapy for CLL comprising two medicines named venetoclax (Venclexta) and obinutuzumab (Gazyva). This combination therapy is approved for the initial treatment of adult patients with chronic lymphocytic leukemia (CLL). The combination of venetoclax and obinutuzumab can also be used for small lymphocytic lymphoma (SLL).
Nitin Goswami

Nitin Goswami

Nitin Goswami joined us as an Editor in 2020. He covers all the updates in the field of Pharmaceutical, Business Healthcare, Health News, Medical News, and Pharma News.

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