Leukemia Stages

After you are diagnosed with leukemia, your physician will determine the stage of your cancer to help guide your treatment plan. For most solid tumor cancers, staging is determined by the size of the tumor and how it has spread in the body. Since leukemia is a blood cancer and does not cause tumors to form, the stage of your cancer is described by the amount of cancerous white blood cells in the body and the accumulation of these cells in other organs.

When staging your leukemia, your physician may consider your white blood cell count, age, and health history, as well as any chromosome abnormalities, bone damage, or enlargement of your liver or spleen. Each type of leukemia affects the body differently and has its own staging system.

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Acute Lymphocytic Leukemia (ALL)

Acute lymphocytic leukemia is categorized by your white blood cell count at the time of your diagnosis and describes the response of your cancer to treatment.

Untreated: This describes a new diagnosis of ALL before you begin receiving treatment.
Remission: This occurs after treatment. Patients in remission have five percent or less cancerous bone marrow cells, white blood cell counts in a normal range, and are no longer experiencing symptoms. Patients are considered in complete molecular remission when there is no remaining evidence of cancer. Patients with minimal residual disease still have some evidence of cancer in their bone marrow and may be monitored more closely for signs they are no longer in remission.
Recurrent: Leukemia that has come back after treatment is considered recurrent. Patients will need more testing and treatment at this stage.

Chronic Lymphocytic Leukemia (CLL)

There are two staging systems that are commonly used to stage chronic lymphocytic leukemia:

Rai Staging System

Low risk/Stage 0: Patients have an abnormal increase in lymphocytes in their blood and bone marrow.
Intermediate risk/Stages I and II: In addition to an abnormal increase in lymphocytes, patients have either enlarged lymph nodes or an enlarged spleen and/or liver.
High risk/Stages III and IV: In addition to an abnormal increase in lymphocytes, patients have a decreased number of red blood cells (anemia) or a decreased number of platelets (thrombocytopenia).

Binet Staging System

A Stage: Patients have less than three areas of enlarged lymph tissue and do not have anemia or thrombocytopenia.
B Stage: Patients have more than three areas of enlarged lymph tissue and do not have anemia or thrombocytopenia.
C Stage: Patients have any number of areas of enlarged lymph tissue, as well as anemia and/or thrombocytopenia.

Acute Myeloid Leukemia (AML)

Like ALL, there is no standard staging system for acute myeloid leukemia, and the cancer is described by its response to treatment.

Untreated: AML is newly diagnosed. Patients have an abnormal blood cell count, at least 20 percent of the cells in their bone marrow are leukemia cells, and they have signs or symptoms of leukemia [link to signs and symptoms page].
Remission: AML has been treated and patients have a normal blood cell count with less than 5 percent of leukemia cells in the bone marrow. Patients show no signs or symptoms of leukemia.
Refractory: This describes AML that does not go into remission after treatment.
Recurrent: AML has reappeared in the blood or bone marrow after remission.

Chronic Myeloid Leukemia (CML)

Physicians divide chronic myeloid leukemia into three phases based on the number of leukemia cells in the blood or bone marrow.

Chronic phase: Most patients are diagnosed at this stage. Less than 10 percent of the cells in the blood or bone marrow are leukemia cells. Patients usually experience mild symptoms, like fatigue.
Accelerated phase: Between 10 and 19 percent of cells in the bone marrow and blood are leukemia cells. Patients usually experience more symptoms, including fever, poor appetite, and weight loss.
Blastic phase: More than 20 percent of cells in the bone marrow and blood are leukemia cells, and these cells have spread throughout the body. Patients may experience fever, poor appetite, and weight loss.

Chronic Myelomonocytic Leukemia

Chronic Myelomonocytic Leukemia is divided into two groups describing leukemia cell counts in the blood and bone marrow.

CMML-1: Cancerous cells are less than five percent of white blood cells and less than 10 percent of bone marrow cells.
CMML-2: Cancerous cells are between five and 20 percent of white blood cells or between 10 and 20 percent of bone marrow cells.