Stages of Leukemia: Acute and Chronic Leukemia Stages

Most types of cancer are assigned a stage depending on tumor growth and whether or not the cancer has metastasized (spread to other organs in the body). However, staging of leukemia is different from that of other cancers. Some types of leukemia have no staging criteria, and those that do use different staging criteria than other cancers.

Why is Staging of Leukemia Different?

One of the key goals of cancer staging is to determine the size of the tumor and how far the cancer has spread through the body. However, in the case of leukemia, there is no need to do this. Because leukemia is a bone marrow cancer, it has already spread throughout the entire body via the bloodstream.

By the time leukemia is diagnosed, the disease has often spread to other organs (most commonly the lymph nodes, liver and spleen). Staging of leukemia, then, is less about the spread of cancer and more concerned with other elements of the disease.

Stages of Leukemia and Acute Leukemia

Acute leukemia isn't classified in stages. Acute myelogenous leukemia (AML) is classified by the subtype of AML that affects the patient, and whether or not the cancer has spread from the blood and bone marrow to other parts of the body.

Adult acute lymphocytic leukemia (ALL) is staged in three categories:

• In remission
• Recurrent
• Untreated.

The staging of childhood ALL uses risk groups:

• High risk
• Recurrent
• Standard risk (low risk).

Chronic Leukemia Stages

Chronic leukemia stages depend on the type of leukemia diagnosed. Chronic myelogenous leukemia (CML) and chronic lymphocytic leukemia (CLL) are staged in different ways.

CML is divided into three phases:

• Chronic phase: CML produces mild symptoms and responds well to treatment. Patient blood counts reveal blast and promyelocyte levels at less than 5 percent (blasts and promyelocyte cells are abnormal immature cells that can replicate themselves).
• Accelerated phase: Symptoms are more pronounced, and treatments are less effective. Blast counts range from 5 to 30 percent.
• Blast phase: Also referred to the acute phase, or "blast crisis," the blast phase sees blast counts rise higher than 30 percent, and the spread of the disease to other organs.

Chronic lymphocytic leukemia stages are usually classified using Rai stages in the United States. The Rai stages are:

• Stage 0: Low risk
• Stages 1 and 2: Intermediate stages
• Stages 4 and 5: High risk.

In Europe, Binet staging is used to stage CLL. This system stages the disease by lymphatic tissue involvement.

Leukemia Final Stages

Because of the different types of leukemia and accompanying staging methods, it’s difficult to generalize about leukemia final stages. Generally, the final stages of leukemia include:

• Involvement of other organs
• Resistance to treatment
• Significant levels of abnormal blood cells.

Each type of leukemia responds to treatment differently and progresses at different rates. Individual response to treatment and disease progression are more useful prognostic indicators than classification systems.

Resources

American Cancer Society. (n.d.). How is leukemia staged? Retrieved March 12, 2010, from http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_leukemia_staged_62.asp.

Oncology Channel. (2009). Leukemia: Staging. Retrieved March 12, 2010, from http://www.oncologychannel.com/leukemias/staging.shtml.

Schoenstadt, A. (n.d.). Stages of leukemia. Retrieved March 12, 2010, from http://leukemia.emedtv.com/leukemia/stages-of-leukemia.html.