Staging acute lymphocytic leukemia

Staging is a way of describing or classifying a cancer based on the extent, or amount, of cancer in the body. Cancers that form solid tumours are given numbered stages based on the size of the tumour and if the cancer has spread to lymph nodes or other parts of the body.

Acute lymphocytic leukemia (ALL) has no standard staging system. The phases of ALL are described as untreated, in remission, relapsed (also called recurrent) or refractory.

Untreated

Untreated ALL means that the leukemia is newly diagnosed and hasn’t been treated yet. Untreated ALL is defined by the following:

  • there are low numbers of normal red blood cells, white blood cells and platelets
  • usually more than 25% of the cells in the bone marrow are immature white blood cells (called blast cells, or blasts)
  • there are signs and symptoms of ALL

Doctors use a complete blood count (CBC) to check the numbers of different types of blood cells.

Remission

After ALL is treated, the leukemia can be in remission.

Complete remission, or complete response, means that all of these criteria apply:

  • the numbers of blood cells (red blood cells, white blood cells and platelets) are normal
  • less than 5% of the cells in the bone marrow are blast cells
  • there are no general signs or symptoms of ALL, such as fatigue, weight loss, fever, anemia or bleeding
  • there are no signs or symptoms of leukemia in the brain and spinal cord (called the central nervous system, or CNS) or anywhere else in the body

Partial remission means that less than 25% of the cells in the bone marrow are blast cells.

Relapsed

Relapsed, or recurrent, ALL means the leukemia has come back after treatment and reaching remission. Relapse means that more than 25% of the cells in the bone marrow are blast cells.

Refractory

Refractory disease means the leukemia did not respond to treatment.

Expert review and references

  • American Cancer Society. Leukemia - Acute Lymphocytic (Adults). Atlanta, GA: American Cancer Society; 2013.
  • American Society of Clinical Oncology (ASCO). Leukemia - Acute Lymphocytic - ALL: Subtypes and Classification. Alexandria, VA.: American Society of Clinical Oncology (ASCO); 2013: http://www.cancer.net/cancer-types/leukemia-acute-lymphocytic-all/subtypes-and-classification.
  • National Cancer Institute. Adult Acute Lymphoblastic Leukemia Treatment (PDQ®) Health Professional Version. Bethesda, MD: National Cancer Institute; 2014.
  • Tuzner NN, Bennett JM . Classification of the acute leukemias: cytochemical and morphologic considerations. Wiernik PH, Goldman JM, Dutcher JP & Kyle RA (eds.). Neoplastic Diseases of the Blood. 5th ed. Springer; 2013: 16: pp. 213-239.