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.

Evidence for a macromolecular complex in poor prognosis CLL that contains CD38, CD49d, CD44 and MMP‐9

“…Progressive CLL is defined by expansion of the neoplastic clone and extravascular accumulation in lymphoid tissues, the bone marrow and other organs. Infiltration at these sites gives rise to the characteristic clinical picture of immune dysfunction, lymphadenopathy, splenomegaly and haematopoietic failure; features that correlate with survival (Rai et al, 1975;Binet et al, 1981). In addition, it is now clear that interactions within the tissues between leukaemic and non-malignant cells provide signals important for maintaining and promoting the growth of the tumour (Deaglio et al, 2005;Edelmann et al, 2008;Patten et al, 2008).…”

Due to low infection rates no routine anti‐infective prophylaxis is required in younger patients with chronic lymphocytic leukaemia during fludarabine‐based first line therapy

“…Patients in Binet stage A were included, if they had severe B-symptoms. Disease stage was assessed according to the Binet or Rai classification (Rai et al, 1975;Binet et al, 1981), and treatment requirement was according to the NCI criteria (Cheson et al, 1996). To be eligible for enrolment all patients had to be younger than 66 years.…”

Selective effect of cyclosporine monotherapy for pure red cell aplasia not associated with granular lymphocyte‐proliferative disorders

“…On bone marrow examination, myeloid and megakaryocytic maturation was normal in 6/7 patients. In®ltration by >40% lymphocytes, which suggests the diagnosis of chronic lymphocytic leukaemia (Binet et al, 1981;Rai et al, 1975), was found Cell percentages shown were determined by¯ow cytometry at the time of admission. Percentages shown are those of the total number of peripheral blood mononuclear cells.…”