Binet and Rai staging systems
Clinical staging of chronic lymphocytic leukemia
Binet Clinical Stage
|A||Lymphocytosis, does not meet criteria for stages B or C|
|B||≥ 3 areas of lymphadenopathy*, does not meet criteria for stage C|
|C||Anemia (Hb < 10 g/dL) or thrombocytopenia (platelets < 100 x109/L)|
Adapted from Binet et al, 1981.1
Modified Rai Clinical Stage
|Risk category||Clinical features|
|Low||Lymphocytes > 15 x 109/L|
|Intermediate||As 0 + lymphadenopathy or hepato- or splenomegaly|
|High||Anemia (Hb ≤ 11 g/dL) or thrombocytopenia (platelets ≤ 100 x109/L)|
Rai Clinical Stage (original)
|0||Lymphocytes >15 x 109/L|
|I||As 0 + lymphadenopathy|
|II||As 0 + hepato- or splenomegaly|
|III||As 0 + anemia (Hb < 11 g/dL)|
|IV||As 0 + thrombocytopenia (platelets < 100 x109/L)|
The Binet clinical staging system for CLL1 comprises three stages, while the original Rai clinical staging system3 has five stages. A simpler, modified Rai clinical staging system with three stages has been proposed.2
The use of clinical staging systems is recommended in current CLL guidelines, and can guide the initiation of treatment: patients with Binet stage A (or Rai stage 0) disease do not usually require treatment. Treatment can be considered for those with Binet stage B (or Rai stage I or II) disease. Most patients with Binet stage C (or Rai stage III or IV) disease require treatment.4
CLL: chronic lymphocytic leukemia
OS: overall survival
- Binet JL, Auquier A, Dighiero G, Chastang C, Piguet H, Goasguen J et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer 1981; 48: 198-206.
- Rai KR. A critical analysis of staging in CLL. In: Gale RP, Rai KR, eds. Chronic Lymphocytic Leukemia: Recent Progress and Future Directions. New York, NY: Liss; 1987:253-264.
- Rai KR, Sawitsky A, Cronkite EP, Chanana AD, Levy RN and Pasternack BS. Clinical staging of chronic lymphocytic leukemia. Blood 1975; 46: 219-234.
- Hallek M, Cheson BD, Catovsky D, Caligaris-Cappio F, Dighiero G, Döhner H et al. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008; 111: 5546-5556.