Stages of Leukemia
After being diagnosed with leukemia, your hematologist-oncologist will determine the extent of your cancer. This process, known as staging, is an essential part of treatment planning. Unlike other cancers, where staging is based on the size and spread of tumors, leukemia staging assesses the state of blood cells and bone marrow. Factors that influence leukemia staging and prognosis include:
- White blood cell or platelet count
- Age
- Any history of blood disorders
- Enlarged liver or spleen
- Bone damage
- The presence of inherited chromosome mutations, specifically the Philadelphia chromosome
Below are the various staging systems used for the four most common types of leukemia.
Acute Lymphocytic (Lymphoblastic) Leukemia (ALL) Stages
Doctors do not typically use traditional staging methods for ALL. Instead, they rely on cytogenetic tests, flow cytometry, and other lab tests, while also considering the patient's age. These tests provide detailed information about the subtype of ALL and its prognosis, and help categorize ALL based on gene and chromosome changes in leukemia cells.
The World Health Organization (WHO) divides ALL into the following groups:
- B-Cell ALL: B lymphocytes, or B cells, are a type of white blood cell crucial for fighting infections(humoral immunity) by making antibodies against antigens.
- T-Cell ALL: T cells are essential for cell-mediated immunity and play a vital role in hosting an immune response against pathogens.
Acute Myeloid Leukemia (AML) Stages
There are two main classification systems used to categorize AML: the French-American-British (FAB) classification and the newer World Health Organization (WHO) classification.
French-American-British (FAB) Classification
The FAB classification was developed in the 1970s by a team of leukemia experts from France, America, and Britain. It divides AML into subtypes, numbered M0 through M7. This classification is based on the type of cells from which the leukemia develops and their maturity level, primarily on how they appear under the microscope after routine staining.
AML subtypes M0 through M5 begin in very early (immature) white blood cells. Subtype M6 starts in very immature red blood cells, and M7 begins in immature cells that form platelets.
- M0: Undifferentiated acute myeloblastic leukemia
- M1: Acute myeloblastic leukemia with minimal maturation
- M2: Acute myeloblastic leukemia with maturation
- M3: Acute promyelocytic leukemia (APL)
- M4: Acute myelomonocytic leukemia
- M4 eos: Acute myelomonocytic leukemia with eosinophilia
- M5: Acute monocytic leukemia
- M6: Acute erythroid leukemia
- M7: Acute megakaryoblastic leukemia
World Health Organization (WHO) Classification
The WHO classification system considers multiple factors known to impact prognosis and provides a better categorization of AML:
- AML with specific genetic abnormalities (gene or chromosome changes)
- AML with myelodysplasia-related changes
- AML related to previous chemotherapy or radiation
- AML not otherwise specified (including cases that do not fit the above groups)
- Myeloid sarcoma (also known as granulocytic sarcoma or chloroma)
- Myeloid proliferations related to Down syndrome
- Undifferentiated and biphenotypic acute leukemias (leukemias exhibiting both lymphocytic and myeloid features), sometimes referred to as mixed phenotype acute leukemias (MPALs)
Chronic Lymphocytic Leukemia (CLL) Stages
Unlike many other cancers that form tumors, CLL typically affects the bone marrow and blood. By the time of diagnosis, it often spreads to other organs, such as the spleen, liver, and lymph nodes. The staging of CLL relies on information gathered from lab tests and imaging studies.
There are two main staging systems for CLL: the Rai and Binet systems. The Rai system is more commonly used in the United States and focuses on lymphocytosis, which is the presence of too many lymphocytes in the blood that is not due to infection.
The Rai system classifies CLL into five stages based on blood test results and physical examination findings. These stages are generally classified into three risk categories when doctors are determining treatment options: low (stage 0), intermediate (stages I and II), and high-risk (stages III and IV).
- Stage 0: Lymphocytosis present; no enlargement of lymph nodes, spleen, or liver; red blood cell and platelet counts are nearly normal
- Stage I: Lymphocytosis with enlarged lymph nodes; spleen and liver are not enlarged; red blood cell and platelet counts are nearly normal
- Stage II: Lymphocytosis with enlarged spleen and/or liver; lymph nodes may or may not be enlarged; red blood cell and platelet counts are nearly normal
- Stage III: Lymphocytosis present; lymph nodes, spleen, or liver may or may not be enlarged; red blood cell counts are low (anemia); platelet counts are nearly normal
- Stage IV: Lymphocytosis present; enlarged lymph nodes, spleen, or liver; red blood cell counts may be low or nearly normal; platelet counts are low (thrombocytopenia)
Chronic Myeloid Leukemia (CML) Stages
Chronic Myeloid Leukemia (CML) is classified into three phases that help predict the outlook. Instead of "stages," doctors refer to these as phases, which are primarily based on the number of immature white blood cells (blasts) in the blood or bone marrow.
The three phases of CML are:
- Chronic: This is the earliest phase of CML, where most patients experience mild symptoms, particularly fatigue, and usually respond well to standard treatments.
- Accelerated: If the CML does not respond well to treatment during the chronic phase, it can progress to the accelerated phase. Symptoms may become more noticeable and can include fever, poor appetite, and weight loss.
- Blastic: This is the most aggressive phase of CML, characterized by having more than 20% blasts. Symptoms in this phase resemble those of acute myeloid leukemia.
Blood Cancer Doctors Specializing in Leukemia in the Syracuse Area
At Hematology-Oncology Associates of CNY, we are committed to providing expert, patient-centered cancer care for all types of leukemia. Our team ensures each patient receives a personalized treatment plan based on the latest advancements in cancer care.
Our cancer centers provide care for patients in Central New York, including the Syracuse area, Onondaga County, Cayuga County, Cortland County, Herkimer County, Jefferson County (including Watertown), Madison County (including Oneida), Oneida County (including Utica and Verona), and Oswego County (including Fulton and Oswego).
