Staging of CLL
Staging is carried out to find out how far the disease has progressed and to determine prognosis for survival.3 Stages were developed using an agreed-upon set of criteria that have been shown to work for a large number of patients.3,8
There are 2 main staging methods that are used in CLL—Rai Staging and the International Staging System, also called the Binet System. Rai Staging is the most commonly used method of staging in the United States, while the Binet System is most commonly used in Europe.4 The Rai stages are presented below.
Rai Staging9
Stage 0—increased number of lymphocytes in the blood (ie, more than 15,000 lymphocytes in a cubic mm of blood)
Stage I—increased number of lymphocytes plus enlarged lymph nodes
Stage II—increased number of lymphocytes plus enlarged liver and/or spleen
Stage III—increased number of lymphocytes plus anemia due to bone marrow failure
Stage IV—increased number of lymphocytes plus reduced platelet count due to bone marrow failure
In stage II, lymph nodes may or may not be enlarged and in stages III and IV the lymph nodes, liver, and spleen may or may not be enlarged.9
Campath is indicated as a single agent for the treatment of B-cell chronic lymphocytic leukemia (B-CLL).
WARNING: CYTOPENIAS, INFUSION REACTIONS, and INFECTIONS
Cytopenias: Serious, including fatal, pancytopenia/marrow hypoplasia, autoimmune idiopathic thrombocytopenia, and autoimmune hemolytic anemia can occur in patients receiving Campath. Single doses of Campath greater than 30 mg or cumulative doses greater than 90 mg per week increase the incidence of pancytopenia [see WARNINGS AND PRECAUTIONS (5.1)].
Infusion Reactions: Campath administration can result in serious, including fatal, infusion reactions. Carefully monitor patients during infusions and withhold Campath for Grade 3 or 4 infusion reactions. Gradually escalate Campath to the recommended dose at the initiation of therapy and after interruption of therapy for 7 or more days [see DOSAGE AND ADMINISTRATION (2) and WARNINGS AND PRECAUTIONS (5.2)].
Infections: Serious, including fatal, bacterial, viral, fungal, and protozoan infections can occur in patients receiving Campath. Administer prophylaxis against Pneumocystis jiroveci pneumonia (PCP) and herpes virus infections [see DOSAGE AND ADMINISTRATION (2.2) and WARNINGS AND PRECAUTIONS (5.3)].
The most commonly reported adverse reactions are infusion reactions fever, chills, hypotension, urticaria, nausea, rash, tachycardia, dyspnea), cytopenias (neutropenia, lymphopenia, thrombocytopenia, anemia), and infections (CMV viremia, CMV infection, other infections). In clinical trials, the frequency of infusion reactions was highest in the first week of treatment. Other commonly reported adverse reactions include vomiting, abdominal pain, insomnia and anxiety. The most commonly reported serious adverse reactions are cytopenias, infusion reactions, and immunosuppression/infections. See "Warnings and Precautions," and "Adverse Reactions" sections of full Prescribing Information.
Please see Full Prescribing Information (PDF).
