Blood cancers

Consensus on acute leukaemia workup

A new US guideline, the Initial Diagnostic Workup of Acute Leukaemia, highlights the increasing complexity of defining the nearly 50 distinct subtypes of acute leukaemia.

The guideline reinforces the 2016 revision of the WHO classification of myeloid neoplasms and acute leukaemia.

 Dr Ashley Ng, clinical haematologist at the Victorian Comprehensive Cancer Centre and translational research fellow at the Walter and Eliza Hall Institute, said the guideline was an important and comprehensive document that reflected current clinical practice in Australia.

He told the limbic there would be only agreement in Australia with the guideline’s 27 statements.

“This is a good consensus document which summarises state of art practice and sets a standard that is maintained in most specialist centres for the treatment of acute leukaemia.”

“The document also reinforces the importance of early referral for specialised assessment of patients with suspected or confirmed acute leukaemia,” he said.

The guideline from the College of American Pathologists and the American Society of Hematology incorporated a systematic review of the evidence and consensus from a panel of experts.

Dr Ng said almost half the statements set the baseline for good practice regarding the collection and communication of patient information and the collection of appropriate samples.

Most would be adhered to in NATA accredited laboratories, he said, although some testing to detect minimal residual disease (MRD) required additional accreditation.

The guideline made a strong recommendation for sufficiently comprehensive flow cytometry or molecular characterization analysis on initial diagnostic material in order to detect MRD on subsequent samples.

Mutational analysis for specific genes associated with particular leukaemia types was also outlined in the document.

“More than half of patients won’t be cured with chemotherapy alone,” Dr Ng said.

“Treatment can be complicated and intense, and require a multidisciplinary approach. Specific mutations can guide our treatment options or help stratify patients for clinical trials.”

The guideline made no recommendation for or against the use of global/gene-specific methylation, microRNA expression, or gene expression analysis for either diagnosis or prognosis.

“For certain tests, we don’t yet have a good understanding of their clinical utility but they are included here from an investigational or research point of view,” Dr Ng said

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