What Are the Stages of Chronic Lymphocytic Leukemia?

This content has been reviewed and approved by

Hagop M. Kantarjian, MD
Chairman & Professor, Leukemia Department
MD Anderson Cancer Center
University of Texas

It is important for your physician to know the stage of your disease. Staging is a system for describing how far the cancer has spread in the body. This information is essential when deciding the best treatment for you. Here is a list of the stages of chronic lymphocytic leukemia (CLL), which we refer to often as Rai stages, after Dr. Kanti Rai who described them in 1975. 

• Rai Stage 0: CLL is found only in the blood and bone marrow.
• Rai Stage I: CLL is found in lymph nodes.
• Rai Stage II: CLL involves the liver and/or spleen, with enlargement of these organs by simple physical exam.
• Rai Stage III: CLL is now causing anemia.
• Rai Stage IV: CLL is now causing low platelet counts.

This staging system is important because it predicts survival. It also gives a guide as when treatment of CLL should begin.

You may also experience general symptoms from your disease. Patients may have fatigue, fever, night sweats, or significant weight loss.

Indolent CLL: Some people diagnosed with CLL have "indolent" disease. This usually refers to when they have a long "doubling time" of the peripheral lymphocyte count (usually more than 1 year), a good hemoglobin level (usually more than 12 grams per deciliter), and a low total lymphocyte count (usually less than 30,000 per microliter). These patients have the best survival times; in fact many live their normal life span without needing any therapy.