Over 40 years of Rai CLL staging system celebrated

Blood are currently celebrating their 70th year by featuring flashbacks of key papers from their history, accompanied by new editorials. One of these flashbacks featured the seminal paper by Rai et al. in which they described a system to stage and predict CLL patient outcome through a physical exam and complete blood count.

The Rai system has five stages and the original publication incorporated data from 125 CLL patients. The authors in this publication helped to illustrate the value of grouping a large number of patients together in order to better understand CLL patient prognosis and ultimately help improve patient outcome. Due to the system being simple and based on just two criteria, it is commendable that over 40 years after publication the Rai staging system is still being used. The Lymphoma Hub congratulates both Rai et al. on their landmark publication and Blood on celebrating their 70th anniversary.

Original Rai et al. Abstract:

Clinical staging of chronic lymphocytic leukemia

A method of clinical staging of chronic lymphocytic leukemia (CLL) has been proposed which is based on the concept that CLL is a disease of progressive accumulation of nonfunctioning lymphocytes: stage O, bone marrow and blood lymphocytosis only; stage 1, lymphocytosis with enlarged nodes; stage II, lymphocytosis with enlarged spleen or liver or both; stage III, lymphocytosis with anemia; and stage IV:lymphocytosis with thrombocytopenia. Analysis of 125 patients. in the present series showed the following median survival times (in months) from diagnosis: stage 0, is greater than 150; stage I 101; stage II, 71; stage III, 19; stage IV, 19, The median survival for the entire series was 71 mo. The prognostic significance of the stage remained even after adjustment was made for age and sex. However, both sex and age were shown to be poor predictors of survival after adjustment for stage. The method of staging proved to be a reliable predictor of survival whether used at diagnosis or during the course of the disease. The proposed staging system was an equally accurate indicator for survival when applied to two other previously published studies of large series of patients.

  1. Rai K.R. et al. Clinical staging of chronic lymphocytic leukemia. Blood. 1975; 46(2):219–234.
  2. Blood Editors. Blood Flashback Editorial. Blood. 2016; 128:2109; doi:10.1182/blood-2016-08-737650.