Bone marrow aspirate Photo by Chad McNeeley
Two physician groups have published an evidence-based guideline that addresses the initial workup of acute leukemia.
The guideline includes 27 recommendations intended to aid treating physicians and pathologists involved in the diagnostic and prognostic evaluation of acute leukemia samples, including those from patients with acute lymphoblastic leukemia, acute myeloid leukemia, and acute leukemias of ambiguous lineage.
The guideline, which was developed through a collaboration between the College of American Pathologists (CAP) and the American Society of Hematology (ASH), has been published in the Archives of Pathology and Laboratory Medicine.
The recommendations in the guideline will also be available in a pocket guide and via the ASH Pocket Guides app in March.
“With its multidisciplinary perspective, this guideline reflects contemporary, integrated cancer care, and, therefore, it will also help providers realize efficiencies in test management,” said ASH guideline co-chair James W. Vardiman, MD, of the University of Chicago in Illinois.
To create this guideline, Dr Vardiman and his colleagues sought and reviewed relevant published evidence.
The group set out to answer 6 questions for the initial diagnosis of acute leukemias:
1) What clinical and laboratory information should be available?
2) What samples and specimen types should be evaluated?
3) What tests are required for all patients during the initial evaluation?
4) What tests are required for only a subset of patients?
5) Where should laboratory testing be performed?
6) How should the results be reported?
The authors say the guideline’s 27 recommendations answer these questions, providing a framework for the steps involved in the evaluation of acute leukemia samples.
In particular, the guideline includes steps to coordinate and communicate across clinical teams, specifying information that must be shared—particularly among treating physicians and pathologists—for optimal patient outcomes and to avoid duplicative testing.
“The laboratory testing to diagnose acute leukemia and inform treatment is increasingly complex, making this guideline essential,” said CAP guideline co-chair Daniel A. Arber, MD, of the University of Chicago.
“New gene mutations and protein expressions have been described over the last decade in all types of acute leukemia, and many of them impact diagnosis or inform prognosis.”
