Binet and Rai staging systems

Clinical staging of chronic lymphocytic leukemia

Binet Clinical Stage

StageClinical features
ALymphocytosis, does not meet criteria for stages B or C
B≥ 3 areas of lymphadenopathy*, does not meet criteria for stage C
CAnemia (Hb < 10 g/dL) or thrombocytopenia (platelets < 100 x109/L)
* The four lymphadenopathy areas are: cervical, axillary, inguinal, spleen/liver
Adapted from Binet et al, 1981.1

Modified Rai Clinical Stage

Risk categoryClinical features
LowLympho­cytes > 15 x 109/L
Inter­mediateAs 0 + lymph­adenopathy or hepato- or spleno­megaly
HighAnemia (Hb ≤ 11 g/dL) or thrombo­cyto­penia (platelets ≤ 100 x109/L)
Adapted from Rai et al, 1987.2

Rai Clinical Stage (original)

StageClinical features
0Lymphocytes >15 x 109/L
IAs 0 + lymphadenopathy
IIAs 0 + hepato- or splenomegaly
IIIAs 0 + anemia (Hb < 11 g/dL)
IVAs 0 + thrombocytopenia (platelets < 100 x109/L)
Adapted from Rai et al, 1975.3

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