Diagnosing and Staging Leukemia

To accurately diagnose leukemia, the City of Hope care team may need to perform several tests to determine the leukemia type and stage, or how advanced the disease is. In addition to a routine physical exam and taking a patient’s medical and family history information, City of Hope staff may also perform the following diagnostic procedures.

Complete blood count
This basic test obtains an accurate count of all the different types of blood cells. The hallmark of leukemia is an overabundance of white blood cells (leukocytes) and this may be the first sign that alerts the doctor to the presence of leukemia.

Bone marrow aspirate and biopsy
Bone marrow tissue is extracted and examined by a pathologist under a microscope to determine if the suspected tissue is cancerous and, if so, classify the leukemia according to cell type and other parameters.

Lumbar puncture (spinal tap)
In some types of leukemia, doctors need to look for leukemia cells in cerebrospinal fluid surrounding the brain and spinal cord. In this procedure, the lower back is numbed and some of the spinal cord fluid is withdrawn using a needle. The fluid is then examined microscopically.

Cytochemistry and immunocytochemistry
Cytochemistry refers to using special stains and chemical reactions to differentiate between types of leukemia. Immunocytochemistry uses the same principle, employing antibodies to produce distinct color changes in the cell sample. Both of these techniques allow the pathologist to identify the type of leukemia present.

Immunophenotyping classifies cells according to their immunity characteristics. The presence or absence of certain antigens and cell surface markers are very useful in determining the leukemia’s cell origin, as well as in predicting whether the leukemia is likely to be aggressive or slow-growing.

Cytogenetics (chromosome analysis)
Since some leukemias are caused by chromosome abnormalities, getting a complete chromosome analysis may provide important diagnostic information that can guide treatment.

Molecular testing, including polymerase chain reaction testing
This test examines genes in the leukemia cell. The presence of certain genes, called oncogenes, can help diagnose precisely what form of leukemia is present. For example, in chronic myelogenous leukemia, an oncogene called bcr-abl is often the determining factor in making a diagnosis.
Stages of Leukemia
Leukemia is described or staged according to its subtype. Currently, acute myeloid or lymphoblastic leukemia (AML/ALL) do not have a standard staging system and are described as untreated, in remission or recurrent.
Chronic leukemia are staged according to how widespread the abnormal cells are in the bone marrow and bloodstream.
By accurately describing or staging the leukemia, the care team can then properly plan for appropriate treatments in accordance to how aggressive or advanced the disease is.
Staging Chronic Myelogenuous Leukemia (CML):
  • Chronic phase: In chronic phase CML, fewer than 10% of the cells in the blood and bone marrow are blast cells.
  • Accelerated phase: In accelerated phase CML, 10% to 19% of the cells in the blood and bone marrow are blast cells.
  • Blastic phase: In blastic phase CML, 20% or more of the cells in the blood or bone marrow are blast cells. When tiredness, fever, and an enlarged spleen occur during the blastic phase, it is called blast crisis.
Staging Chronic Lymphocytic Leukemia (CLL):
  • Stage 0: Lymphocytosis and no enlargement of the lymph nodes, spleen, or liver, and with near normal red blood cell and platelet counts.
  • Stage I: Lymphocytosis plus enlarged lymph nodes. The spleen and liver are not enlarged and the red blood cell and platelet counts are near normal.
  • Stage II: Lymphocytosis plus an enlarged spleen (and possibly an enlarged liver), with or without enlarged lymph nodes. The red blood cell and platelet counts are near normal.
  • Stage III: Lymphocytosis plus anemia (too few red blood cells), with or without enlarged lymph nodes, spleen, or liver. Platelet counts are near normal.
  • Stage IV: Lymphocytosis plus thrombocytopenia (too few blood platelets), with or without anemia, enlarged lymph nodes, spleen, or liver.
If you have been diagnosed with leukemia or are looking for a second opinion consultation about your treatment, find out more about becoming a patient or contact us at 800-826-HOPE.