CLL/SLL with Binet stage A — lymphocytosis with <3 involved lymphoid areas, no anemia, no...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-BINET-A`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CLL`
Sources	`SRC-ESMO-CLL-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	CLL/SLL with Binet stage A — lymphocytosis with <3 involved lymphoid areas, no anemia, no thrombocytopenia — watch-and-wait candidate; no survival benefit from early treatment
Clinical direction	de-escalate
Category	risk-score
Shifts algorithm	ALGO-CLL-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "cll_binet_stage",
      "value": "A"
    },
    {
      "finding": "cll_binet_risk",
      "value": "low"
    }
  ],
  "type": "composite_score"
}

Notes

Binet A (Binet 1981) = <3 involved lymphoid areas (cervical, axillary, inguinal +/- liver/spleen) AND Hb ≥10 g/dL AND plt ≥100K. Median OS >10 yr. iwCLL 2018 + ESMO + NCCN concur: Binet A without active disease criteria (progressive cytopenia, bulky/symptomatic lymphadenopathy, doubling lymphocytes <6 mo, autoimmune cytopenia refractory to steroids, B-symptoms) does NOT meet treatment indication. CLL12 (Langerbeins 2019) showed ibrutinib monotherapy in Binet A high-genetic-risk improved EFS but not OS — early treatment in stage A remains non-standard outside trials.

Used By

Algorithms

ALGO-CLL-1L - ALGO-CLL-1L

Red flag

RF-RAI-LOW - CLL/SLL with Rai stage 0 (lymphocytosis only, no nodes / spleen / cytopenia) — watch-and-...