Staging means finding out how much chronic lymphocytic leukemia (CLL) is affecting your body. For CLL, physicians use a staging system called the Rai system. Your Rai stage is based on the levels of your blood cells and if some organs are enlarged. This helps your physicians predict if your disease is likely to get worse (high-risk disease) and if you need treatment.
The decision to start treatment also depends on other factors that tell us about your risk. Your physician will explain these factors, how we check them and what we know about your risk level.
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CLL International Prognostic Index
The CLL International Prognostic Index (CLL-IPI) is an important tool that helps your physician assess your risk. It uses several things to come up with a score that can guide your treatment choices. These things include:
- If you have certain gene changes (mutations) or missing genes (deletions)
- Your blood cell levels
- If any of your tissues or organs are enlarged
- Your age
- Disease-specific blood tests
Overall Stage Grouping
Physicians use the Rai system with Roman numerals 0, I (1), II (2), III (3) and IV (4) to name CLL stages. Stage 0 is the least advanced, and stage IV is the most advanced. All stages can be treated.
- Stage 0, low risk: You have a higher-than-normal level of lymphocytes in your blood.
- Stages I and II, intermediate risk: You have a higher-than-normal level of lymphocytes in your blood. Your lymph nodes are larger than normal. Your liver or spleen is also larger.
- Stages III and IV, high risk: You have a higher-than-normal level of lymphocytes in your blood. You do not have enough red blood cells or platelets. (Your lymph nodes, spleen or liver may or may not be larger than normal.)
Staging Tests
To figure out the stage of your CLL and predict the outlook for your disease, you may need blood and bone marrow tests and imaging tests.
- Blood and marrow tests show your levels of lymphocytes, red blood cells and platelets.
- Imaging tests show if lymph nodes or other organs are bigger than normal.