Division Chief: Stuart Goldberg, MD
Quality Indicators:
- ML: A bone marrow with standard karyotyping will be performed at diagnosis to confirm stage of disease.
- CML: A bone marrow with standard karytoyping will be performed at 1 year of treatment to confirm treatment response, and to exclude secondary MDS clones.
- CLL: FISH cytogenetics will be performed prior to (or simultaneous with) starting a new chemotherapy regimen, with particular attention to p53 and chromosome 11 abnormalities.
- AML: All newly diagnosed patients under the age of 65 will be offered a bone marrow transplantation consultation to determine appropriateness of therapy at diagnosis or at time of relapse.
- AML: All patients will undergo either FISH or standard karyotyping at diagnosis.
- ALL: All newly diagnosed patients under the age of 65 will be offered a bone marrow transplantation consultation to determine appropriateness of therapy at diagnosis or at time of relapse.
- ALL: All patients will undergo either FISH or pcr based studies to exclude the bcr-abl translocation at diagnosis.
- MDS: FISH or standard karytyping will be performed prior to (or simultaneous with) starting active (non-growth factor) therapy.
- MDS: Documentation of iron stores.
All Patients
- All patients with solid tumors are staged according to ACoS standards.
- All patients who are receiving chemotherapy have a plan documented prior to administration of therapy.
Diagnostic Work Up:
Acute Myeloid Leukemia
| ICD 9 Codes |
| 202.50 |
| 202.51 |
| 202.52 |
| 202.53 |
| 202.54 |
| 202.55 |
| 202.56 |
| 202.57 |
| 202.58 |
| 202.60 |
| 202.61 |
| 202.62 |
| 202.63 |
| 202.64 |
| 202.65 |
| 202.66 |
| 202.67 |
| 202.68 |
| 204.20 |
| 204.21 |
| 204.22 |
| 204.80 |
| 204.81 |
| 204.82 |
| 204.90 |
| 204.91 |
| 204.92 |
| 205.00 |
| 205.01 |
| 205.02 |
| 205.20 |
| 205.21 |
| 205.22 |
| 205.30 |
| 205.31 |
| 205.32 |
| 205.80 |
| 205.81 |
| 205.82 |
| 205.90 |
| 205.91 |
| 205.92 |
| 206.00 |
| 206.01 |
| 206.02 |
| 206.10 |
| 206.11 |
| 206.12 |
| 206.20 |
| 206.21 |
| 206.22 |
| 206.80 |
| 206.81 |
| 206.82 |
| 206.90 |
| 206.91 |
| 206.92 |
| 207.00 |
| 207.01 |
| 207.02 |
| 207.10 |
| 207.11 |
| 207.12 |
| 207.20 |
| 207.21 |
| 207.22 |
| 207.80 |
| 207.81 |
| 207.82 |
| 208.00 |
| 208.01 |
| 208.02 |
| 208.10 |
| 208.11 |
| 208.12 |
| 208.20 |
| 208.21 |
| 208.22 |
| 208.80 |
| 208.81 |
| 208.82 |
| 208.90 |
| 208.91 |
| 208.92 |
| 238.5 |
| 238.76 |
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
Uric Acid
|
|
LDH
|
|
β-2 microglobulin
|
|
Serum protein electrophoresis, quantitative IgG level
|
|
Core or excisional biopsy (FNA not sufficient) with immunophenotyping (immunophenotyping should include CD3, CD5, CD10, CD20, bcl-2, bcl-6, MIB1, TdT, CD4, CD8)
|
|
Bone Marrow Aspirate and Biopsy including Flow Cytometry
|
|
Marrow Cytogenetics (standard karyotype)
|
|
FISH t(14;18)
|
|
Lumbar puncture
|
|
Viral serologies (HIV, acute hepatitis panel, HepBsAb, CMV IgG)
|
|
CT Chest/Abdomen/Pelvis
|
|
PET Scan (Optional)
|
|
Cardiac ejection fraction (If anthracycline based therapy considered) (Optional)
|
|
Central venous catheter (If poor venous access) (Optional)
|
|
Bone Marrow Transplantation Consult (If not in remission by cycle 2) (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Acute Lymphocytic Leukemia
| ICD 9 Codes |
| 202.50 |
| 202.51 |
| 202.52 |
| 202.53 |
| 202.54 |
| 202.55 |
| 202.56 |
| 202.57 |
| 202.58 |
| 204.00 |
| 204.01 |
| 204.02 |
| 204.20 |
| 204.21 |
| 204.22 |
| 204.80 |
| 204.81 |
| 204.82 |
| 204.90 |
| 204.91 |
| 204.92 |
| 208.00 |
| 208.01 |
| 208.02 |
| 208.20 |
| 208.21 |
| 208.22 |
| 208.80 |
| 208.81 |
| 208.82 |
| 208.90 |
| 208.91 |
| 208.92 |
| 238.5 |
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
PT/PTT
|
|
Fibrinogen
|
|
LDH
|
|
Bone Marrow Aspirate and Biopsy
|
|
Immunophenotyping by Flow Cytometry (marrow preferred)
|
|
Marrow Cytogenetics (standard karyotype)
|
|
FISH for common lymphocytic abnormalities (marrow preferred, blood acceptable if blasts present)
|
|
PCR bcr-abl p 190
|
|
Viral serologies (HIV, acute hepatitis panel, CMV IgG)
|
|
HTLV-I/II serologies (If T-cell immunophenotype) (Optional)
|
|
HLA typing (intermediate resolution) (notify blood bank of results if platelet refractoriness develops)
|
|
CT Chest/Abdomen/Pelvis
|
|
Cardiac ejection fraction (If anthracycline based therapy considered) (Optional)
|
|
Central venous catheter (If any treatment offered other than hospice) (Optional)
|
|
Lumbar puncture (If treatment other than hospice) (may be delayed until peripheral blasts are cleared) (Optional)
|
|
Family history regarding potential sibling donors (Optional)
|
|
Bone Marrow Transplantation Consult (Optional if greater than 55 years of age or not receiving aggressive induction therapy) (Optional)
|
|
~ Scheduled by day 28 if persistent blasts
|
|
~ Scheduled before cycle 2 consolidation if remission obtained
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Chronic Myelogenous Leukemia
| ICD 9 Codes |
| 202.40 |
| 202.41 |
| 202.42 |
| 202.43 |
| 202.44 |
| 202.45 |
| 202.46 |
| 202.47 |
| 202.48 |
| 205.10 |
| 205.11 |
| 205.12 |
| 205.30 |
| 205.31 |
| 205.32 |
| 205.80 |
| 205.81 |
| 205.82 |
| 205.90 |
| 205.91 |
| 205.92 |
| 206.10 |
| 206.11 |
| 206.12 |
| 206.80 |
| 206.81 |
| 206.82 |
| 206.90 |
| 206.91 |
| 206.92 |
| 208.10 |
| 208.11 |
| 208.12 |
| 208.80 |
| 208.81 |
| 208.82 |
| 208.90 |
| 208.91 |
| 208.92 |
| 238.5 |
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
LAP score
|
|
Uric Acid
|
|
Spleen size measurement (physical exam or radiograph acceptable)
|
|
Bone Marrow Aspirate (Biopsy optional)
|
|
Immunophenotyping by Flow Cytometry
|
|
Marrow Cytogenetics (standard karyotype)
|
|
Quantitative PCR for bcr-abl p210 (blood)
|
|
Bcr-abl mutational analysis (for patients with resistance, not recommended on initial diagnosis)
|
|
HLA typing (intermediate resolution) (Optional)
|
|
Family history regarding potential sibling donors (Optional)
|
|
Bone Marrow Transplantation Consult (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion (Optional)
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Chronic Lymphocytic Leukemia
| ICD 9 Codes |
| 202.40 |
| 202.41 |
| 202.42 |
| 202.43 |
| 202.44 |
| 202.45 |
| 202.46 |
| 202.47 |
| 202.48 |
| 204.10 |
| 204.11 |
| 204.12 |
| 204.80 |
| 204.81 |
| 204.82 |
| 204.90 |
| 204.91 |
| 204.92 |
| 208.10 |
| 208.11 |
| 208.12 |
| 208.80 |
| 208.81 |
| 208.82 |
| 208.90 |
| 208.91 |
| 208.92 |
| 238.5 |
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
LDH
|
|
Uric Acid
|
|
β-2 microglobulin
|
|
Reticulocyte count
|
|
Coombs (direct)
|
|
Quantitative Immunoglobulin G level
|
|
Bone Marrow Aspirate and Biopsy (Optional)
|
|
Immunophenotyping by Flow cytometry including CD23 and CD38 (marrow or blood; must exclude leukemic mantle cells)
|
|
FISH for common lymphocytic abnormalities (6q-, 11q-, +12, 13p-, 17q-) (marrow or blood)
|
|
FISH for t(11;14) to exclude mantle cell leukemia
|
|
ZAP-70 by flow cytometry (not immunohistochemistry) (marrow or blood) (Optional)
|
|
IgVH mutational status (Optional)
|
|
Anti-platelet antibodies (Optional)
|
|
CT Chest/Abdomen/Pelvis (prior to initiation of therapy)
|
|
Family history regarding potential sibling donors (Optional)
|
|
Bone Marrow Transplantation Consult (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Myelododysplastic Syndromes
| ICD 9 Codes |
|
238.5
|
|
238.72
|
|
238.73
|
|
238.74
|
|
238.75
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Reticulocyte count
|
|
Serum B12 and Folate
|
|
Serum ferritin, iron and TIBC
|
|
Serum erytohropoietin level (preferably prior to transfusion)
|
|
Bone Marrow Aspirate and Biopsy (including iron stains)
|
|
Immunophenotyping by Flow Cytometry (marrow preferred, blood acceptable if blasts present) (Optional)
|
|
Marrow Cytogenetics (standard karyotype)
|
|
FISH for common myeloid abnormalities (marrow preferred, blood acceptable if blasts present)
|
|
PNH evaluation (CD55 and CD59) if marrow hypocellular (Optional)
|
|
PDGFRβ gene arrangement (5q31-33) in patients with CMML (Optional)
|
|
Viral serologies (HIV, acute hepatitis panel, CMV IgG)
|
|
HLA typing (intermediate resolution) (notify blood bank of results if platelet refractoriness develops; confirm HLA DR15 status)
|
|
Central venous catheter (for long-term transfusional support) (Optional)
|
|
Family history regarding potential sibling donors (Optional)
|
|
Bone Marrow Transplantation Consult (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Burkitt's Leukemia (ALL L3)
| ICD 9 Codes |
| 204.82 |
| 208.80 |
| 208.81 |
| 208.82 |
| 208.90 |
| 208.91 |
| 208.92 |
| 238.5 |
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
Uric Acid
|
|
LDH
|
|
β-2 microglobulin
|
|
Serum protein electrophoresis, quantitative IgG level
|
|
Core or excisional biopsy (FNA not sufficient) with immunophenotyping (immunophenotyping should include CD3, CD5, CD10, CD20, bcl-2, bcl-6, MIB1, TdT, CD4, CD8)
|
|
Bone Marrow Aspirate and Biopsy including Flow Cytometry
|
|
Marrow Cytogenetics (standard karyotype)
|
|
FISH t(14;18)
|
|
Lumbar puncture
|
|
Viral serologies (HIV, acute hepatitis panel, HepBsAb, CMV IgG)
|
|
CT Chest/Abdomen/Pelvis
|
|
PET Scan (Optional)
|
|
Cardiac ejection fraction (If anthracycline based therapy considered) (Optional)
|
|
Central venous catheter (If poor venous access) (Optional)
|
|
Bone Marrow Transplantation Consult (If not in remission by cycle 2) (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
Myeloproliferative Disorders
|
|
| Diagnostic Work Up |
|
History & Physical Examination
|
|
CBC
|
|
Full Chemistry Panel
|
|
LAP score
|
|
Uric Acid
|
|
Spleen size measurement (physical exam or radiograph acceptable)
|
|
Bone Marrow Aspirate and Biopsy (with iron and reticulin stains)
|
|
Immunophenotyping by Flow Cytometry
|
|
Marrow Cytogenetics (standard karyotype)
|
|
Quantitative PCR for bcr-abl p210
|
|
JAK-2 mutational analysis by PCR
|
|
PDGFRβ gene rearrangement (5q31-33) in patients with CMML (Optional)
|
|
HLA typing (intermediate resolution) (Optional)
|
|
Family history regarding potential sibling donors (Optional)
|
|
Bone Marrow Transplantation Consult (Optional)
|
|
Fertility discussion (Optional)
|
|
Advanced Directive discussion
|
|
Consult with research team prior to initiation of therapy to confirm trial eligibility
|
|
|
