Guidelines for the Management of Haematological Malignancies

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17 PRECURSOR CELL LYMPHOBLASTIC LEUKAEMIA IN ADULTS Diagnostic Criteria 17.1 Precursor B-cell Lymphoblastic Leukaemia Typical Cases • Bone marrow or solid tissue infiltration with blast cells • Immunophenotype: CD19+, CD22+, Tdt+, CD117-, CD34var, CD45 wk Variants • CD10 and cytoplasmic µ heavy chain define common and pre-B subtypes according to traditional criteria. These distinctions are of no clinical value. • BCR-ABL associated phenotype: CD34-homo+++, CD10-homo+, CD13+ and/or CD33+, CD38wk/-. • t(12;21) associated: common ALL phenotype with CD10-hetero+, CD13+ and/or CD33+. 17.2 Precursor T-lymphoblastic Leukaemia Typical Cases • Bone marrow or solid tissue infiltration with blast cells • Immunophenotype: CD19-, Tdt+, cCD3+, CD2+, CD7+, CD22-, MPO- (by flow) Definition of Remission Status When a blast cell population with a leukaemia-associated phenotype is detected unequivocally by flow cytometry on the basis of patterns of CD34, CD19, CD20 and CD10 expression or PCR this will be reported as not in remission, with the extent of infiltration stated. Where these techniques are not available remission will be defined as a morphological blast cell count of
Patients aged 15-24 (up to 25th birthday) with Ph neg ALL: Already ceased to be eligible for UKALLXII at the most recent amendment and should be entered into UKALL2003. They should be offered treatment and or support from adolescent unit in Leeds if possible. (Level 2) Patients aged 15-24 (up to 25th birthday) with Ph pos ALL: UKALLXII Ph positive arm is still open. Having entered UKALL2003 and found to be Ph positive, such patients should transfer back to UKALLXII Ph pos arm (Level 2) Adults (Ph+ve) eligible but not in trial Should be treated with the current NCRI UKALL XII trial protocol. Early notification to the transplant team is essential for these patients. (Level 2) Adults too old for trial entry Fit patients who are only a few years older than the cut-off could be discussed with the trial coordinators. It should be remembered that the prognosis for patients 50-60 years and older is poor, particularly if there are other poor prognostic features (e.g. Ph+ve/ t(4;11)). A ‘step-down’ approach in intensity is suggested as follows: 1. Fit, informed and willing: consider a UKALL XII–like schedule in this circumstance but note the above cautions. (Level 2) 2. Less fit, older or uncertain: a less intensive schedule is appropriate. Induction with 2 doses of daunorubicin, weekly vincristine x 4, asparaginase and prednisolone (similar to the previous UKALL Xa schedule) is effective and may be followed with a consolidation block or simply standard maintenance at the clinician’s discretion. CNS prophylaxis is with serial LPs only. (Level 2) 3. Elderly or frail: Vincristine x4 (1mg) and prednisolone followed by standard maintenance is simple. CNS prophylaxis may be considered on a case-by-case basis, and would be with serial lumbar punctures following the completion of the vincristine phase. (Level 1) Treatment of primary refractory disease This will be defined post 2nd phase induction in UKALL XII regime or equivalent time point in other treatments. • See below for a discussion of the use of Imatinib in Ph+ve cases. Refractory disease has a dismal outlook with no schedule being clearly optimal. • We suggest HyperCVAD(Kantarjian, O'Brien et al. 2000) for B cell ALL and hyper- CVAD/CLAEG for T cell ALL as a preference in this network, with other alternatives including FLAG or High dose Ara-C schedules e.g. HAM**. (Level 2) * The fludarabine and Ara-C doses and schedule are as in the MRC AML-HR protocol. http://leuktrials.uwcm.ac.uk/trials/aml/current/aml-hr/protocol/protocol.htm The G-CSF is given for 7 days, starting the day before the chemotherapy. No G-CSF dose is standard – we suggest 1 vial of Lenograstim 263mcg or Filgrastim 300mcg daily s/c. (HAM schedule: footnote next page) ** HAM schedule is: Ara-C 1g/m2 bd i.v. days 1-4 (by 3 hour infusion), Mitoxantrone 10mg/m 2 daily i.v. days 3-5, and ‘triple intrathecal therapy’ all on day 1 only, consisting of methotrexate 15mg, Ara-C 40mg and Methylprednisolone 40mg all given once IT. It may be worth discussing these patients with the trial co-ordinators and they should all be reviewed at the MDT. Treatment of ALL relapsing after CR(Fielding, Richards et al. 2007) Guidelines for the Management of Haematological Malignancies 17. PRECURSOR CELL LYMPHOBLASTIC LEUKAEMIA IN ADULTS 43
Page 1 and 2: Yorkshire Cancer Network and Humber
Page 3 and 4: 18 MYELODYSPLASTIC SYNDROMES ......
Page 5 and 6: 2 IMAGING FOR HAEMATOLOGICAL MALIGN
Page 7 and 8: 3 CLASSICAL HODGKIN LYMPHOMA Key Is
Page 9 and 10: Assessments • Assessments should
Page 11 and 12: 5 DIFFUSE LARGE B-CELL LYMPHOMA (DL
Page 13 and 14: • Patients not considered candida
Page 15 and 16: 7 FOLLICULAR LYMPHOMA Key Issues
Page 17 and 18: 8 CHRONIC LYMPHOCYTIC LEUKAEMIA The
Page 19 and 20: Initial therapy for advanced CLL Th
Page 21 and 22: 9 MANTLE CELL LYMPHOMA Key Issues U
Page 23 and 24: • Splenectomy should only be cons
Page 25 and 26: • Surgery is generally to be avoi
Page 27 and 28: 13 PERIPHERAL T-CELL LYMPHOMA Key I
Page 29 and 30: Relapse Treatment • Patients with
Page 31 and 32: Essential Investigations • CT sca
Page 33 and 34: • Peripheral blood for flow cytom
Page 35 and 36: Guide to treatment options by stage
Page 37 and 38: 15.3 Plasmacytoma of Bone Diagnosti
Page 39 and 40: 15.6 Amyloidosis Primary and Relaps
Page 41: Primary Treatment BCSH guidelines s
Page 45 and 46: 18 MYELODYSPLASTIC SYNDROMES Diagno
Page 47 and 48: • Both the degree of thrombocytop
Page 49 and 50: • Patients presenting in blast cr
Page 51 and 52: A more difficult decision concerns
Page 53 and 54: Diagnostic Criteria With the except
Page 55 and 56: 21.4 Reporting Standards All specim
Page 57 and 58: All members of Haemato-oncology MDT
Page 59 and 60: 22.3 Clinical Support • On-site a
Page 61 and 62: • Principle treatment centres mus
Page 63 and 64: • It is envisaged that relevant s
Page 65 and 66: 24.4 Acute Myeloid leukaemia There
Page 67 and 68: Data Collection The network is obli
Page 69 and 70: 27 FLIP Index for Follicular Lympho
Page 71 and 72: 29 BINET DISEASE STAGE FOR CLL STAG
Page 73 and 74: 31 ECOG PERFORMANCE STATUS Grade EC
Page 75 and 76: 33 WEBSITES UK Websites HMDS www.hm
Page 77 and 78: Dearden, C. E., E. Matutes, et al.
Page 79 and 80: Mead, G. M., M. R. Sydes, et al. (2
Page 81 and 82: 35 Appendices DRAFT Haematological
Page 83 and 84: CT: Routine staging should include
Page 85 and 86: Multiple Myeloma and Related Disord
Page 87: Host factor, Microbiological and cl

Guidelines for the Management of Haematological Malignancies

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