Until recently researching CLL was a dead end in a hematologist’s career, but Dr. Binet and Dr. Kanti Rai changed that with their staging of CLL.
Their staging began to organizing thinking around CLL and helps sort out the wide heterogeneity or differences seen in the outcomes of different CLL patients. CLL became more predictable, more sortable and therefore more accessible to researchers.
Below is a comparison of the two staging systems for chronic lymphocytic leukemia. Remember that both systems were designed before the molecular/genomic era and remain in use today, especially for prognosis in untreated patients.
Timeline:
- 1975 – Rai staging (USA):
Kanti Rai and colleagues published a staging system in Blood that stratified CLL based on lymphocytosis, lymphadenopathy, splenomegaly/hepatomegaly, anemia, and thrombocytopenia. - 1981 – Binet staging (France/Europe):
Jean-Louis Binet and colleagues published their simpler system in Cancer, focusing on the number of involved lymphoid areas and presence of *anemia or thrombocytopenia.
Rai vs. Binet
System
Stage(s)
Criteria
Risk Grouping
Rai (1975)
Stage 0
Lymphocytosis only
Low
Stage I
+ Lymphadenopathy
Intermediate
Stage II
+ Splenomegaly and/or Hepatomegaly
Intermediate
Stage III
+ Anemia (Hb < 11 g/dL)
High
Stage IV
+ Thrombocytopenia (<100 ×10⁹/L)
High
Binet (1981)
Stage A
< 3 lymphoid areas involved, no anemia or thrombocytopenia
Early
Stage B
≥ 3 lymphoid areas involved, no anemia or thrombocytopenia
Intermediate
Stage C
Anemia and/or thrombocytopenia, regardless of nodal involvement
Advanced
The genius of their observation and their clinical relevance is what made these staging systems so useful to this very day.
Those were the days before flow cytometry and genetic testing, days when physicians had to rely solely on their diagnostic acumen to manage their patients. Days before “Test before Treat.”
Dr. Binet passed late last year at 92 years old. I had the pleasure of meeting him late in his life. Dr. Rai is still as sharp as ever in his mid 90s, but his impaired mobility limits his ability to practice medicine. He saw his last patient in august of 2025. I consulted him at Long Island Jewish early in my CLL journey and we stayed friends since. He was a wonderful doctor. The CLL community is diminished by his retirement.
An era is passing. Dr. Kipps shares this wonderful remembrance of Dr. Binet closing with the line: “With his passing, hematology is not widowed, but orphaned.”
If you want a personal response, or just want to stay in touch, please email me at [email protected]. I have no other way of contacting. Thanks. Stay strong. After all, we are all in this together. And please visit our website: http://cllsociety.org for the latest news and information. Google serves cookies to analyze traffic to this site. Information about your use of our site is shared with Google for that purpose..
