Clinical staging of chronic lymphocytic leukemia

Abstract

A method of clinical staging of chronic lymphocytic leukemia (CLL) has been proposed which is based on the concept that CLL is a disease of progressive accumulation of nonfunctioning lymphocytes: stage O, bone marrow and blood lymphocytosis only; stage 1, lymphocytosis with enlarged nodes; stage II, lymphocytosis with enlarged spleen or liver or both; stage III, lymphocytosis with anemia; and stage IV:lymphocytosis with thrombocytopenia. Analysis of 125 patients. in the present series showed the following median survival times (in months) from diagnosis: stage 0, is greater than 150; stage I 101; stage II, 71; stage III, 19; stage IV, 19, The median survival for the entire series was 71 mo. The prognostic significance of the stage remained even after adjustment was made for age and sex. However, both sex and age were shown to be poor predictors of survival after adjustment for stage. The method of staging proved to be a reliable predictor of survival whether used at diagnosis or during the course of the disease. The proposed staging system was an equally accurate indicator for survival when applied to two other previously published studies of large series of patients.

Production of β2‐microglobulin by chronic lymphocytic leukaemia cells in vitro

“…In a previous study (9) of 23 patients with CLL we found a correlation between S-P,m level and tumour cell mass as estimated with Rai's clinical staging (10) and from peripheral lymphocyte count. It was also found that 3 patients with an increased CLL cell proliferative activity, indicating disease progression (1 I), had very high S-p2m levels.…”

Prognostic significance of a morphometric study of lymph node biopsies in chronic lymphocytic leukaemia

“…These results suggest that the quantification of the large lymphoid cells component with a positive skewness coefficient reflects an active disease in the lymph node. However, no significant correlation between morphological characteristics of well-differentiated lymphocytic pro-liferation and clinical categories has been found in previous studies (9), but in a large series of CLL lymph node biopsies Lennert (10) found a high percentage of pseudo-follicular cases with foci of large cells corresponding to the so-called 'active CLL' with a poorer prognosis. Our results are in agreement with this data and suggest a correlation between clinical stage and histological grading.…”

“…In lymph node biopsies, CLL is characterized by a diffuse proliferation of small lymphocytes with a variable number of large lymphoid tu-mour cells (6, 7). The number and the distribution of these large cells are the basis for some histomorphological subclassifications (8,9,10). Although it has been stated that small lymphocytic proliferations which contain a greater number of large lymphoid cells have a more aggressive evolution (1 l), the relationship between smaller numbers of large lymphoid cells and the clinical course remains to be defined with precision (8,9).…”

Survival and prognostic factors in chronic lymphocytic leukemia

“…The inconsistent findings reported in the literature probably express the great variability in the CLL populations and the diversity of the clinical course. In 1975, Rai et a1 introduced their simple 5-stage system, based on easily obtainable clinical and hematological data (3). The validity of this staging system has been confirmed in many subsequent series and thus became the standard staging method.…”