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Multidisciplinary Approach to Older Adults with Hematologic Malignancies-a Paradigm Shift. Curr Hematol Malig Rep 2022; 17:31-38. [PMID: 35028826 PMCID: PMC8757625 DOI: 10.1007/s11899-021-00646-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/04/2022]
Abstract
Hematologic malignancies are most likely to present in the seventh and eighth decades of life. Continued population growth will lead to increasing numbers of older adults with hematologic malignancies. Oncology care for older adults is complex and must account for the effect of aging on disease biology and treatment tolerance. Multidisciplinary oncology care has been utilized in solid tumor oncology for decades, initially driven by the need for multi-modality treatment. In this review, we make the case for multidisciplinary oncogeriatric care for older adults with hematologic malignancies in order to best navigate the intersection of aging and blood cancer.
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Quirós C, Fonseca A, Alonso-Álvarez S, Moro-García MA, Alonso-Arias R, Morais LR, Álvarez-Menendez FV, Colado E. Development of an algorithm for the identification of leukemic hematolymphoid neoplasms in Primary Care patients. Diagnosis (Berl) 2021; 8:239-247. [PMID: 32284442 DOI: 10.1515/dx-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/26/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diagnosis of hematolymphoid neoplasm (HLN) requires different technologies which are performed on a patient basis instead of per protocol. We hypothesize that integration of hematimetric and cytological analysis along with multiparametric flow cytometry (MFC) provides a framework to evaluate peripheral blood (PB) samples from Primary Care. METHODS Samples from patients with persistent (>3 months) lymphocytosis (>5 × 109/L) and/or monocytosis (>109/L) or the presence of atypical and/or blast cells upon the smear review were analyzed by MFC concurrent to cytological analysis. MFC studies were carried out following standardized procedures. RESULTS In a 3-year period, smear review and MFC were performed simultaneously in 350 samples, demonstrating HLN in 194 cases (55.4%). In 156 cases, reactive cell populations were found. The combination of age, absolute lymphocyte count (ALC), hemoglobin and platelets provided the best correlation with MFC for the presence of a chronic lymphoproliferative disorder (CLPD) in lymphocytosis [area under the curve (AUC) 0.891, p < 0.05]. A model evaluating the probability of CLPD has been proposed and validated in an independent cohort. CONCLUSIONS A strategy to perform MFC studies following standardized procedures has proven to be useful to evaluate samples from patients in Primary Care centers for HLN diagnosis or reactive conditions, providing a sensitive and rapid clinical orientation and avoiding unnecessary consultations in routine clinical practice. The probability for the presence of CLPD in PB can be calculated and help guide decision-making regarding further testing.
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Affiliation(s)
- Covadonga Quirós
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Ariana Fonseca
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sara Alonso-Álvarez
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Rebeca Alonso-Arias
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Lucía-Rita Morais
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Francisco V Álvarez-Menendez
- Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Enrique Colado
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Avda. Roma s/n - 33011 Oviedo, Spain; Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Avda. Roma s/n - 33011 Oviedo, Spain; and Hematology and Haemotherapy Department, Laboratory of Medicine, Hospital Universitario Central de Asturias, Oviedo, Spain, Phone: +34 985 10 80 00, Ext 37138
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Pearson LN, Miller JM, Lunde JH, Bryant RJ, Lewis MR, Tang ME. Combined Pathology-Driven Algorithmic Testing and Integrated Reporting for Bone Marrow Examination. Arch Pathol Lab Med 2019; 143:732-737. [PMID: 30672336 DOI: 10.5858/arpa.2018-0161-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The College of American Pathologists published guideline recommending bone marrow synoptic reporting for hematologic neoplasms. OBJECTIVE.— To evaluate the impact of pathology-driven algorithmic testing (PDAT) with integrated reporting for bone marrow examination on test utilization, ability to render a specific World Health Organization diagnosis, and clinician satisfaction 1 year after implementation. DESIGN.— We reviewed the hematopathology reports, integrated synoptic reports, and ancillary test results generated during a 12-month period. The initial diagnosis from the hematopathology report was compared with the final diagnosis on the integrated synoptic reports. Test utilization data were compared with a previous year in which ancillary testing was ordered at clinician discretion. Clinicians were anonymously surveyed to assess their satisfaction with PDAT and integrated reporting. RESULTS.— Integrated reporting resulted in a World Health Organization diagnosis for 80 of 85 cases (94%) compared with 54 (64%) for the hematopathology report alone. Unnecessary testing decreased from 45% pre-PDAT (124 of 274 cases) to 0.7% PDAT (2 of 268 cases), and PDAT resulted in fewer omissions of necessary tests. Clinicians preferred PDAT and valued integrated reporting for a variety of reasons, including the ease of finding relevant prognostic information. CONCLUSIONS.— Pathology-driven algorithmic testing with integrated reporting improves the pathologist's ability to render a specific World Health Organization diagnosis and improves test utilization. Clinicians prefer PDAT to clinician-ordered testing. This is the first study to examine how synoptic reporting can modify hematologic diagnoses.
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Affiliation(s)
- Lauren N Pearson
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
| | - Jill M Miller
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
| | - John H Lunde
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
| | - Ronald J Bryant
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
| | - Michael R Lewis
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
| | - Mary E Tang
- From the Department of Pathology and ARUP Laboratories, University of Utah, Salt Lake City (Dr Pearson); the Department of Pathology, Oregon Health Sciences University, Portland (Dr Miller); and the Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington (Drs Lunde, Bryant, Lewis, and Tang). Dr Tang is now retired
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Köhnke T, Wittmann VK, Bücklein VL, Lichtenegger F, Pasalic Z, Hiddemann W, Spiekermann K, Subklewe M. Diagnosis of CLL revisited: increased specificity by a modified five-marker scoring system including CD200. Br J Haematol 2017; 179:480-487. [PMID: 28832948 DOI: 10.1111/bjh.14901] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/18/2017] [Indexed: 01/21/2023]
Abstract
The modified Matutes score has been the basis for the diagnosis of chronic lymphocytic leukaemia (CLL) by flow cytometry for the past 15 years. To increase the specificity of the current score we systematically evaluated the diagnostic value of established as well as novel markers, such as CD200, in a large cohort of patients with untreated B-cell malignancies (n = 370). Double positivity for CD5 and CD23 was of very high value to differentiate between CLL and non-CLL cases. In addition, lack of FMC7 expression as well as CD79b expression intensity showed high sensitivity (90·4% and 92·3%) with acceptable specificity (74·4% and 76·9%). For surface IgM, low or absent expression displayed poor specificity in distinguishing CLL from non-CLL cases (51,3%; sensitivity 83,7%). Finally, CD200 positivity showed high sensitivity and specificity. Therefore, CD5/CD23, FMC7, CD79b and CD200 were included in our new CLLflow score, which retained high sensitivity (97·1% vs. 98·6% for the Matutes score, P = 0·38), but showed markedly increased specificity (87·2% vs. 53·8%, P < 0·001). These results were confirmed in our validation cohort (sensitivity 97·0% vs. 100%, P = not applicable; specificity 86·4% vs. 59·1%, P = 0·03). Our data support the use of our new CLLflow score for the diagnosis of CLL with significantly higher specificity.
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Affiliation(s)
- Thomas Köhnke
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany
| | - Veronika K Wittmann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Veit L Bücklein
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany
| | - Felix Lichtenegger
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany
| | - Zlatana Pasalic
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany
| | - Wolfgang Hiddemann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Karsten Spiekermann
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Marion Subklewe
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany.,Translational Cancer Immunology, Gene Centre, University of Munich, Munich, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
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