Haematology Society of Australia and New Zealand
Recommendations from the Haematology Society of Australia and New Zealand on thrombophilia, lymphoma, venous thromboembolism, leukaemia & thrombocytopenic purpura. Founded in 1998, The Haematology Society of Australia and New Zealand (HSANZ) seeks to promote, foster, develop and assist the study and application of information concerning haematology, and to promote improved standards, interest and research in all aspects of haematology.
2.
Limit surveillance computed tomography (CT) scans in asymptomatic patients with confirmed complete remission following curative intent treatment for aggressive lymphoma – except for patients on a clinical trial
CT surveillance in asymptomatic patients in remission from aggressive lymphoma may be harmful through a small but cumulative risk of radiation-induced malignancy. It is also costly and has not been demonstrated to improve survival. Therefore the anticipated benefits of post-treatment CT scans should be weighed against the potential harm of radiation exposure. Due to a decreasing probability of relapse with the passage of time and a lack of proven benefit, CT scans in asymptomatic patients more than 2 years beyond the completion of treatment are rarely advisable.
Supporting evidence
- Thompson CA, Ghesquieres H, Maurer MJ. Utility of routine post-therapy surveillance imaging in diffuse large B-cell lymphoma. Journal of Clinical Oncology 2014;32:3506-3512.
- Huntington SF, Svoboda J, Doshi JA. Cost-effectiveness analysis of routine surveillance imaging of patients with diffuse large B-cell lymphoma in first remission. Journal of Clinical Oncology 2015;33(13):1467-74.
- Cheah CY, Dickinson M, Hofman MS. Limited clinical benefit for surveillance PET-CT scanning in patients with histologically transformed lymphoma in complete metabolic remission following primary therapy. Annals of Haematology 2014; 93:1193-1200.
- Lin TL, Kuo MC, Shih LY, Dunn P, Wang PN, Wu JH, Tang TC, Chang H, Hung YS, Lu SC. Value of surveillance computed tomography in the follow-up of diffuse large B-cell and follicular lymphomas. Annals of Haematology 2012;91(11):1741-5.
- Thompson CA, Charlson ME, Schenkein E. Surveillance CT scans are a source of anxiety and fear of recurrence in long-term lymphoma survivors. Annals of Oncology 2010;21:2262-6.
- Shenoy P, Sinha R, Tumeh JW, Lechowicz MJ, Flowers CR. Surveillance computed tomography scans for patients with lymphoma: is the risk worth the benefits? Clinical Lymphoma Myeloma Leukemia 2010;10(4):270-7.
- Guppy AE, Tebbutt NC, Norman A, Cunningham D. The role of surveillance CT scans in patients with diffuse large B-cell non-Hodgkin’s lymphoma. Clinical Lymphoma Myeloma Leukemia 2003;44(1):123-5.
How this list was made
The Haematology Society of Australia and New Zealand (HSANZ) council, which includes 9 state representatives, convened to form the working group to produce a ‘top 5’ list for haematology.
Drawing on the list produced by the American and Canadian Societies of Haematology, the working group compiled a list of 5 clinical practices in haematology which may be overused, inappropriate or of limited effectiveness in a given clinical context.
This list was then sent out to all HSANZ members seeking feedback on whether these items fully captured the concerns of clinicians in an Australasian haematology medicine context and if not, whether any items should be omitted and/or new items added.
The criteria used to rate the practices were strength of evidence, significance in haematology and whether haematologists could make a difference in influencing the incidence of the practice in question.
Feedback on the items and the recommendations was received from 11 institutional haematology departments (following intradepartmental consultation) as well as an additional 10 individuals.
Based on these responses, the top 5 items were selected and finalised.
Related recommendations
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1
Do not conduct thrombophilia testing in adult patients under the age of 50 years unless the first episode of venous thromboembolism (VTE):
- occurs in the absence of a major transient risk factors (surgery, trauma, immobility),
- occurs in the absence of oestrogen-provocation,
- occurs at an unusual site
- occurs in the absence of a major transient risk factors (surgery, trauma, immobility),
- 2 Limit surveillance computed tomography (CT) scans in asymptomatic patients with confirmed complete remission following curative intent treatment for aggressive lymphoma – except for patients on a clinical trial
- 3 Do not extend anticoagulation beyond 3 months for a patient with a non-extensive, index venous thromboembolic event (VTE), which occurred in the setting of a major, transient risk factor
- 4 Do not perform baseline or routine surveillance CT scans or bone marrow biopsy in patients with asymptomatic early stage chronic lymphocytic leukaemia (CLL)
- 5 Do not treat patients with immune thrombocytopenic purpura (ITP) in the absence of bleeding or a platelet count <30,000/L without risk factors for bleeding.