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.
4.
Do not perform baseline or routine surveillance CT scans or bone marrow biopsy in patients with asymptomatic early stage chronic lymphocytic leukaemia (CLL)
In patients with asymptomatic, early-stage chronic lymphocytic leukaemia (CLL) , baseline and routine surveillance computed tomography (CT) scans do not improve survival and are not necessary to stage or prognosticate patients. CT scans expose patients to small doses of radiation, and can detect incidental findings that are not clinically relevant but lead to further investigations and are costly. For asymptomatic patients with early-stage CLL, clinical staging and blood monitoring is recommended over CT scans.
Supporting evidence
- Oscier D, Dearden C, Eren E, Fegan C, Follows G, Hillmen P, Illidge T, Matutes E, Milligan DW, Pettitt A, Schuh A, Wimperis J. British Committee for Standards in Haematology. Guidelines on the diagnosis, investigation and management of chronic lymphocytic leukaemia. British Journal of Haematology 2012;159(5):541-64.
- Eichhorst B, Hallek M, Dreyling M, Group EGW. Chronic lymphocytic leukaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology 2010;21 Suppl 5:162-4.
- Hallek M, Cheson BD, Catovsky D. Guidelines for the diagnosis and treatment of chronic lymphocytic leukemia: a report from the International Workshop on Chronic Lymphocytic Leukemia updating the National Cancer Institute-Working Group 1996 guidelines. Blood 2008;111:5446-56.
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.
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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.