Improving Care for Acute Leukemia Patients


The College of American Pathologists (CAP) and the American Society of Hematology (ASH) today published an evidence-based guideline that addresses the initial workup of acute leukemia. The guideline was published in an early online edition of the Archives of Pathology and Laboratory Medicine.

“Initial Diagnostic Workup of Acute Leukemia: Guideline from the College of American Pathologists and the American Society of Hematology” defines the recommended clinical information and laboratory testing needed for proper diagnosis, with the goal of optimal prognosis of pediatric and adult patients with acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), and mixed-phenotype acute leukemia (MPAL).

By relying on this guideline, hematologists, oncologists, pathologists, allied clinicians, and patient advocacy groups can better ensure that each patient receives the most accurate diagnostic testing and subsequent care.

“The laboratory testing to diagnose acute leukemia and inform treatment is increasingly complex, making this guideline essential,” explains Daniel A. Arber, MD, University of Chicago School of Medicine, who served as the CAP representative co-chair for the guideline. “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.”

Most notably, the guideline underscores the essential 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 unnecessary duplicative testing. By identifying the best timing and setting for recommended tests, the guideline also provides structured, baseline recommendations to manage molecular testing.

“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, the University of Chicago School of Medicine.

Drs. Arber and Vardiman led an interdisciplinary team of hematologists and hematopathologists. This panel systematically sought and reviewed published evidence to answer six questions for the initial diagnosis of the specified range of acute leukemias, including of ambiguous lineage:

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?

In addition to the full guideline, the recommendations will also be available in a printed pocket guide and digitally in the ASH Pocket Guides app.

Given the incidence of leukemia, the new CAP/ASH guideline holds promise for broad clinical reach and positive patient impact. Every three minutes, someone in the U.S. is diagnosed with blood cancer, and nearly 176,000 new cases are expected this year. Of these, an estimated 35 percent will be a type of leukemia, according to the Leukemia & Lymphoma Society.

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