Contents

 
Welcome
Back-up of Red Book
ET Disclaimer
Abbreviations
General
Drug Administration and Dosage
Symbols and Units
Using this Documentation
Getting around the documentation
Searching the documentation
Changing your font size
Printing
Sending feedback
Administration
Introduction
Administrative Arrangements for the Haematology Service
Organisation of Laboratory Services
Organisation of Inpatient and Outpatient Services
Hospital/Departmental Meetings
Ancillary Services and Advice for Patients
Cost Implications of Clinical Decisions
Leave
Inability to Report for Duty
Information for Registrars and House Surgeons
Registrar Job Description
Registrar Handy Hints
Cluster Location Manual
Incidents and Consumer Feedback
House Surgeon Handy Hints
Managing Electronic Results in Haematology
Bone Marrow Aspiration and Trephine Biopsy Techniques
Haematology Case Notes
Consent Forms for Haematology Patients
Standard Operating Procedures
Clinical Procedures
Protocol for Bone Marrow Aspirate and Trephine Biopsy
Bone Marrows
Prevention of Bleeding after Bone Marrow Biopsy
Collection of Sample
Aspiration Procedure
Bone Marrow Trephine
Samples for Surface Markers, Cytogenetics and Molecular Oncology
Clinical Trials
Admissions
Medical Responsibilities
Doctors Referring Patients to BMTU
Assessment of New Admissions to BMTU
Laboratory Results
Nursing Responsibilities
Clerical Responsibilities
After-Hours
Electronic Transfer of Radiology Images from Other Hospitals
MRSA
Discharges and Coding
Discharges
Coding
Guidelines for Managing Patients Out-of-Hours
Outpatient Calls
Inpatients Causing Concern
Haematology Day Ward
General Arrangements
Medical Cover for Day Ward
Weekend Laboratory Tests
Haematology Outpatients
Intensive Care Unit (ICU)
ICU Background Information
Referral of Patients to ICU
ICU Response Time
Transfer of Patients to ICU
ICU Management of Haematology Patients
Haematology Management of Patients in ICU
Other Support Available to Haematology Patients in ICU
Communications
Discharge from ICU
Referral for chemotherapy in Timaru Day Ward
Haemostasis Service
Service Description/Staffing
Referrals
Requirements for Patients Referred for Outpatient DVT/PE Treatment
Initial Management
On Call Arrangements
Incidents and Consumer Feedback
Incident Reporting
Patient (Consumer) and Family Feedback
Cardiopulmonary Resuscitation
Inpatient Deaths
Medical Responsibility
Nursing Staff Responsibility
Outpatient Clinics
Time of Outpatient Clinics
Nurse-Led Clinics
Referrals
Adolescent and Young Adults (AYA)
AYA Cancer Service
AYA procedures
Informed Consent
Supportive Care
Monitoring Vital Signs
Venous Access
Central Venous Access Devices (CVAD) - Hickman© Catheter
Indications for Use
Catheter Insertion
Catheter Care
Blood Sampling
Ethanol Locks
Ethanol Treatment
Catheter Complications
Blockage or Slowing
Occlusion
Restoring Catheter Patency
Catheter-Related Thrombosis
Catheter Breakage
Catheter Removal
Before Procedure
Removal of Catheter
PICC/Midlines
Indications for Use
Referrals
Care of PICC/Midlines
Portacaths
Peripheral Vein Cannulas
Contributing Factors for Problems
Care of Cannula
Cannula Infection
CDHB Visual Phlebitis scale
Psychological Support
Anxiety in Cancer Patients
Drug Treatment of Anxiety in Patients with Cancer
Antidepressants
Depression in Cancer Patients
Drug Treatment of Depression in Patients with Cancer
Pre-Transplant Psychological Assessment
Staff Support Services
Nutritional Support
Levels of Nutrition Support
Level 1 - Oral diet
Level 2 - Enteral nutrition
Level 3 - Parenteral nutrition
Aim of Nutrition Support
When to Provide Support
Enteral Nutrition
Guidelines for inserting enteral feeding tubes for patients undergoing transplants
Parenteral Nutrition (PN)
PN - Prescribing, Administration, Monitoring
Stopping PN
Prescribing Nutritional Supplement Drinks
IV fluid and electrolyte replacement
Magnesium Deficiency
Potassium Administration
Mucositis
Pain Management
General Comments Concerning Pain Relief
Steroid-induced Hyperglycaemia
Haematology Patients
Ward Management
Confusion and Delirium
Nausea and Vomiting
Definitions
Chemotherapy and Emetogenic Potential
Cytotoxic Schedules and Choice of Antiemetics
Breakthrough Nausea and Vomiting
Antiemetics for Outpatients
Oral Hygiene/Acute Dental Care
Laxatives
Tumour Lysis Syndrome (TLS)
Prophylaxis
High Risk (>5% risk TLS)
Intermediate Risk (1-5% risk TLS)
Standard Risk (<1% risk TLS)
Management of Tumour Lysis Syndrome
Aggressive Hydration
Rasburicase (recombinant form of urate oxidase)
Rasburicase Dosage
Hyperkalaemia
Hyperphosphataemia
Hypocalcaemia
Renal Failure
Fertility and Menstruation Issues
General comments
Gonadal Function and Stem Cell Transplants
Women and SCT
Men and SCT
Ovarian Tissue Storage
Embryo Freezing
Semen Storage
Information for Health Care Team
Procedure to Organise a Freeze
Therapy Induced Menopause
Initial Assessment
Initiating Treatment
Monitoring of Treatment
Management of Bleeding Complications
Available Preparations
Prevention of Menorrhagia
Osteoporosis Prophylaxis
Pathogenesis
Drug Interactions and Osteoporosis
Management
Prophylaxis
Treatment of Osteoporosis
Lumbar Puncture Procedure
A national standard for intrathecal chemotherapy in New Zealand
Background
Key Points
Intrathecal Chemotherapy Training for Specialist Registrars
Performance Scores
ECOG Performance Status
Karnofsky Performance Status
Palliative Care Performance Score
Sorror Score before Transplant
Table 1. Definitions of comorbidities included in the HCT-CI
Table 2. HCT-CI scores, 2 year survival and hazard ratios for NRM (Non-Relapse Mortality)
WHO Performance Status
Palliative Care
Post-transplant Re-immunisation Schedule
Infection Including Prophylaxis
Prevention of Infection
Quick look infection prevention and control isolation requirements in BMTU
Protective Isolation
Purpose
Associated Documents
Definitions
Hand Hygiene
Single Rooms
Clothing
Visitors
Aprons and gowns
Masks
BMTU Maintenance
HEPA Filter Maintenance
Isolation Room Maintenance
Temperature Maintenance
Microbial Testing
Preventing Infections
Low Bacterial Diet
Bacterial Infections
Hepatitis B Prevention
Herpetic Infections
Pneumocystis Prophylaxis
CMV Prevention
CMV Monitoring
Allografts (Standard or RIC)
Allografts (Standard or RIC) at LOW Risk for CMV viraemia
Other intensively treated patients
Fungal Infections
Fungal Prophylaxis
Itraconazole
Interactions with Posaconazole, Itraconazole and Voriconazole
Influenza and Respiratory Illnesses
Toxoplasmosis Prophylaxis
Prevention of Infection Pre-splenectomy and in Splenic Atrophy
Oral Hygiene
Patients Undergoing High Dose Chemotherapy
Dental Referrals
Mouthcare
Mucositis
Topical Pain Relief
Systemic Pain Relief
Suspected Herpes Simplex
Angular Cheilitis
Lip Care
Xerostomia
Oral cryotherapy for the prevention of high dose melphalan induced stomatitis
Perianal Care
Prevention of Diarrhoea
Summary of Antimicrobial Prophylaxis for SCT
Vaccination Policy in Haematology Patients
Vaccination in Splenectomised/Splenic Atrophy patients
Vaccination Prophylaxis post-SCT
Treatment of Infection in Haematology Patients
Management of the Septic Immunosuppressed Patient
Antibiotics used in Bacterial Infections
Piperacillin/tazobactam (Tazocin®)
Aminoglycosides
Vancomycin
Teicoplanin
Meropenem
Imipenem (Primaxin®)
Cefepime
Ertapenem
Treatment of Fungal Infections
Superficial Candidiasis (Mouth, Throat, Oesophagus)
Systemic Candidiasis
Invasive Aspergillus Infection (IAI) / Fungal PCR Tests
Voriconazole
Liposomal Amphotericin B
Caspofungin
Posaconazole
Treatment of Herpetic Infections
Herpes Simplex
Herpes Zoster
Aciclovir - Dosage in Renal Impairment
Respiratory Tract Infections
Community-Acquired Pneumonia
Upper Respiratory Viruses
Ribavirin for RSV Infections
Diarrhoea and C. difficile
Faecal Specimen Testing
Clostridium Difficile
Toxoplasmosis - Treatment
Clinical Features
Pneumocystis Pneumonia
Clinical Features
Investigations/Diagnosis
Treatment
Acquired CMV Infection - Treatment
Clinical Features
Diagnosis
Treatment
Drug Usage in Haematology
Drug Prescribing
PHARMAC Rules and Regulations
Prescribing Requirements
Patients' Own Medications
Verbal Orders
Standing Orders
Outpatient Prescribing
Special Authority Numbers / Named Patient Pharmaceutical Assessment (NPPA)
Controlled drugs
All At Once (Stat) Dispensing and Close Controls
Medication Availability
Unregistered Medicines (Section 29, Medicines Act 1981)
Medicines Access Programmes, including Compassionate Supply
Drug Information Cards for Patients
Prescription Charts
Individualised Template
Aplastic Anaemia
Acute Lymphoblastic Leukaemia
Acute Myeloid Leukaemia
Chronic Lymphocytic Leukaemia
Hairy Cell Leukaemia
MDS
Myeloma
Non Hodgkin Lymphoma
Rituximab - any indication
Waldenstroms
Oral Chemo Templates
Supportive Care Sheets
Cytotoxic Drugs
Chemotherapy Protocols
Calculating the Dose of Cytotoxic Drugs
Prescription and Preparation of Cytotoxic Drugs
Prescription of Cytotoxic Drugs
Preparation of Cytotoxic Drugs
Guidelines for Rounding of Cytotoxic Drug Doses
Administration of Cytotoxic Drugs
Management of Extravasation of Cytotoxic Drugs
Vesicant Drugs
Irritant Drugs (This List is Not Exhaustive)
Dosage Adjustments in Renal Impairment
Dosage Adjustments in Hepatic Impairment
Cytotoxic Drug Interactions
Oral Cytotoxics
Lumbar Punctures and Intrathecal Cytotoxics
Lumbar Puncture Procedure
Methotrexate (MTX)
Cytarabine (Ara C)
Method of Lumbar Puncture
Examination of CSF
High Dose Methotrexate
Monoclonal Antibodies
Rituximab
Alemtuzumab
Complications of Cytotoxic Chemotherapy
Nausea and Vomiting
Tumour Lysis Syndrome
Cardiotoxicity and Cytotoxic Drugs
Anthracyclines
Prevention
Management of Established Cardiac Failure
Reaction to Cytarabine (Cytarabine Syndrome)
Treatment
Cost of Commonly Used Drugs in Haematology
WHO Toxicity Gradings
Chemotherapy Drugs - Patient Information Leaflets
Prednisone Withdrawal Protocol
Step 1: Reduce steroids to physiological replacement dosage (5 mg/day)
Step 2: Monitor for recovery of normal steroid secretion
Blood Transfusion
Local Transfusion Services
Organisation – NZBS and BMTU
Ordering of Blood Products
Collection and Administration of Blood Transfusions
Issuing Blood Products to BMTU
Blood Product Information
Blood Transfusion
Red Cell Transfusion
Blood Filters
CMV Negative Blood
Irradiated Blood
Blood Component Therapy and SCT
Guidelines for ABO Incompatibility
Rhesus Incompatibility
Major ABO Incompatibility i.e., A, B, or AB donor and O recipient
Minor Incompatibility i.e., O donor and A, B, AB recipient or A1 donor and A2 Recipient
Mixed, Major and Minor Incompatibility i.e., A Donor to B Recipient, Or B Donor to A Recipient
Rh (D) incompatibility
Minor ABO Incompatibility with Donor PBSC Product
Platelet Transfusions
Indications
Verbal Orders
HLA Typing and Antibody Testing
Transfusion Reactions
Mild Transfusion Reaction: Diagnosis and Treatment
Severe Transfusion Reaction: Diagnosis and Treatment
Delayed Transfusion Reactions
Pathophysiology
Clinical Manifestations
Laboratory Diagnosis and Evaluation
Management and Prevention
Transfusion Related Acute Lung Injury (TRALI)
Pathophysiology
Clinical Signs
Laboratory Diagnosis and Evaluation
Management
Transfusion of Infected Blood
Pathophysiology
Clinical Manifestations
Laboratory Diagnosis and Evaluation
Management and Prevention
Transfusion - Associated Graft-Versus-Host Disease
Pathophysiology
Risk Groups
Clinical Manifestations
Prevention
Further Reading
Post-Transfusion Purpura
Pathophysiology
Clinical Manifestations
Laboratory Testing
Management
Use of Anti-D
Intragam P (IV) and Evogam (S/C)
Indications for Intragam P usage
Replacement Therapy
Therapeutic Treatment
Dosage
For Replacement Therapy
For Immunomodulatory Therapy
Indications for Evogam
Treating Adults who Decline Blood Products (including Jehovah's Witnesses)
General Principles of Treatment
Communication
Health-Care Directives
Blood Products and Alternatives
Documentation and Liaison
Checklist of Products/Procedures to Establish Acceptability
Potential clinical situations that may be encountered when caring for patients who decline blood products
The adult patient requiring elective surgery who declines blood products– ‘bloodless surgery’
Bloodless surgery: Maximising the pre-operative haemoglobin level
Bloodless surgery: Estimating the maximum allowable blood loss (MABL)
Bloodless surgery: Reducing blood loss
Bloodless surgery: Post operative anaemia
Acute bleeding in the adult patient who declines blood products
The critically ill and anaemic adult patient who declines blood products
The adult obstetric patient who declines blood products
Antenatal care
Labour and postnatal care including management of massive obstetric haemorrhage
References
Checklist of Products/Procedures to Establish Acceptability
Flowchart: Elective Surgery in Patients who Decline Blood Products
Flowchart: Acute Bleeding in Patients who Decline Blood Products
NZBS Autologous Blood Collection and Transfusion
Therapeutic Plasmapheresis
Overall Supervision and Responsibility
The Transfusion Medical Officer/ Haematologist on Call
Notification of NZBS Apheresis Nurses
Practical Details of Apheresis Procedure
IV Access
Medical Examination of the Patient
Paediatric Patients/Donors
Volume and Access Considerations
Replacement Fluids and Schedules for Plasma Exchange
Cytapheresis
Expected/Physiological Effects vs Untoward/Adverse Effects of Therapeutic Apheresis
Physiological and Adverse effects of Therapeutic Apheresis
Further Detailed Management of Complications (Therapeutic Apheresis)
Patient Information and Consent
Costs of NZBS Blood Products
Anaemia
General Considerations and Causes
Anaemia Due to Decreased Red Cell Production
Iron Deficiency
Causes of Iron Deficiency
Increased Iron Requirements
Inadequate Iron Supply
Clinical and Laboratory Assessment
Management
Oral Iron Treatment
Parenteral Iron
Anaemia of Chronic Inflammation
Megaloblastic Anaemia
Vitamin B12 Deficiency
Causes
Clinical Effects
Diagnosis
Management
Folate Deficiency
Causes
Diagnosis
Management
Other Causes of Megaloblastic Anaemia
Pure Red Cell Aplasia
Introduction and Key Points
Classification
Diagnosis
Management
Aplastic Anaemia
Overview
Clinical Presentation
Classification
Diagnosis
Assessment of Severity and Prognosis
Assessment of Severity
Prognosis
Pre-Treatment Investigations
Management
Key Points
Outline of Treatment for Severe AA
Supportive Care in Aplastic Anaemia
Stem Cell Transplantation
Immunosuppression - ATG/ALG and Cyclosporin
ATG/ALG Guidelines
Test Dose
Administration following test dose
Side Effects
Treatment of Side Effects
Monitoring of Patient
Contraindications of ALG/ATG Treatment
Relapsed / Refractory Disease
Moderate Aplastic Anaemia
Aplastic Anaemia Patient Information Booklet
Anaemia Due to Increased Red Cell Destruction
Thalassaemias
Abnormal Haemoglobins
Red Cell Membrane and Enzyme Defects
Immune Mediated Haemolytic Anaemia
Diagnosis and Management
Paroxysmal Nocturnal Haemoglobinuria (PNH)
Introduction and Key Points
Clinical Presentation
Pathogenesis
Diagnosis
Management
Anaemia in the Elderly
Neutropenia
Causes of Neutropenia
Drug-Induced Neutropenia
Clozapine Induced Neutropenia – Prevention and Management
Thrombocytopenia
Iron Overload
Iron Overload - Hereditary
Definition
Classification of Hereditary and Secondary Causes of Haemochromatosis
Clinical Features
Laboratory Diagnosis
Management
Venesection in Haematology
Iron Overload - Transfusional
Desferrioxamine (DFO)
Thrombotic Disorders
DVT/PE
Venous Thromboembolism - DVT and PE
The Incidence of DVT
Surgical VTE Prophylaxis
Bleeding following New Oral Anticoagulants (e.g. dabigatran)
Axillary Vein Thrombosis
Superficial Vein Thrombosis
Inferior Vena Caval (IVC) Filter
Indications
Outpatient DVT/PE Treatment - The Haemostasis Service
Heparin-induced Thrombocytopenia (HIT)
Management of HIT
Bivalirudin therapy
Dose modifications of the Bivalirudin dosage regimen
Patients scheduled for a switch to oral anticoagulation
Physiological Anticoagulants
HRT/OCP & Thrombosis
Air Travel and Venous Thrombosis
Anti-Phospholipid Syndrome (APS)
Cardinal Features
Treatment Recommendations
Thrombosis + Antiphospholipid Antibody Positive (ACL or LAC)
Pregnant + Antiphospholipid Antibody Positive (ACL or LAC)
Pregnancy & Thrombosis
Prophylaxis
Complications
Investigation for DVT/PE
Treatment
DVT or Pulmonary Embolus
Prophylaxis of DVT/PE
Disseminated Intravascular Coagulation
Pathophysiology
Diagnosis of DIC
Clinical Causes
Management of DIC
Inherited Bleeding Disorders
Management
National Guidelines
General Principles of Treatment
Specialist Management
Terminology
Pain Relief
Acute Joint Bleeding
Recovery
Dosing
Recording Treatment
Vaccinations
Hepatitis B Vaccination
Hepatitis A
Prophylaxis
Haemophilia A
Haemophilia B
Management of Bleeding
Continuous Infusion Regimen
Haemarthroses
Muscle Bleeds
Major Head Injury or Intra Cerebral Bleed
Surgery
Minor Procedures - Endoscopy & Skin Lesions
Major Procedures - General or Orthopaedic Surgery
Dental Procedures
Routine Extraction with Local Anaesthetics
Dental Extraction with Surgical Flaps (General Anaesthesia)
Chronic Knee Synovitis
Intra-articular Injections
Haematuria
Mild Haemophilia
Desmopressin
Factor VIII Concentrates
Patients with Inhibitors to Factor VIII
Introduction
Information Required
Acute Bleeding Management
Acquired Haemophilia
Acquired Factor VIII Deficiency
Obstetric Management of Carrier Women
Management of Mother (Carrier Women)
Potential New Case of Haemophilia
Von Willebrand Disease
Background
Minor Bleeds
Surgery and Major Bleeds
Doses of FVIII-VWF Concentrate (Biostate) for VWF Patients Unresponsive to desmopressin (avail. from Blood Bank)
Pregnancy
Platelet Disorders
Congenital Platelet Function Defects
Acquired Platelet Function Defects
Uraemia
Hepatic Cirrhosis
Myeloproliferative Disorders
Genetic Testing
DNA Diagnosis of Haemophilia A & B
Product Information
Recombinant Factor VIII
Xyntha
Plasma Derived Factor VIII
Biostate - CSL FVIII
Recombinant Factor IX
BeneFIX
Plasma Derived Factor IX
Mono FIX - VF
Recombinant Activated Factor VII (NovoSeven)
Feiba NF
FXIII Concentrate
Desmopressin
Tranexamic Acid
Uses
Side Effects
Conjugated Oestrogens (e.g., Premarin)
Acute Myeloid Leukaemia
Overview
Clinical Features
Classification
Laboratory Diagnosis
Morphology of Blood and Bone Marrow
Immunophenotyping
Cytogenetics
DNA Analysis
The Decision to Treat
Pre-Treatment Investigations for patients whose leukaemia is to be treated with intensive regimens
Management of AML
Introduction and Key Questions
Current Trials in AML
Supportive Care
Emergencies in Acute Leukaemia
AML 19
AML (other than APL) comparisons
AML 19 Trial Information
Remission Criteria
RICT in AML
Ll-1 Trial in AML
Management of non-trial patients
Management of older patients with Acute Myeloid Leukaemia
Management of Relapse or Refractory Patients
Idarubicin / Cytarabine Protocol
Pre-treatment Assessment
Dose Modifications
Initial Treatment
Palliative Care
Low dose cytarabine as per AML14 trial
Etoposide/Thioguanine
Hydroxyurea
Acute Promyelocytic Leukaemia
Overview
Clinical Features
Laboratory Diagnosis
Prognosis and the Decision to Treat
Pre-Treatment Investigations
Management
AML19 APL
Induction
Consolidation
Maintenance
Supportive Care
Differentiation (ATRA) syndrome
Other Side Effects of Tretinoin (ATRA)
Remission Criteria
Treatment of non-trial patients
Management of Relapse or Refractory Patients
Arsenic Treatment
Supportive Care
Myelodysplasia
Overview
Classification
Diagnosis
Assessment of Prognosis
IPSS-R
WPSS
IPSS
CMML Score
Management
Key Points
Supportive Care
Low Risk MDS
Erythropoeitin and GCSF
High risk MDS
Allogenic Stem Cell Transplantation
MPD - CML, CNL, PRV, ET, IM, HES, Mastocytosis
Introduction
Chronic Myeloid Leukaemia - BCR-ABL Positive (CML)
Overview
Clinical findings
Laboratory Diagnosis
Morphology
Cytogenetic and DNA Analysis
Prognosis
Historical perspective of CML treatment
The IRIS trial
Management
Imatinib or Allograft?
Accelerated Phase and Blast Crisis
Cytogenetic and Molecular Monitoring of Patients with CML treated with tyrosine kinase inhibitors
Management of non-haematological toxicity
Management of myelosuppression on imatinib
Response criteria
Polycythaemia Vera
Background
Pathogenesis of Polycythaemia Vera
Diagnosis
Diagnostic criteria for PV (2008 WHO classification)
Clinical assessment
Investigations
Management
Short term therapeutic goals
Hydroxyurea refractory/intolerant PV
Long term therapeutic goals in PV
Referral to GP for shared care
Primary polycythaemia - joint management between specialist care and primary care
Secondary and apparent increased red cell mass
Essential Thrombocythaemia
Pathogenesis
Clinical Findings
Laboratory Results
Diagnosis
Management
Hydroxyurea refractory/intolerant PV
Referral to GP for shared care
Essential thrombocythaemia - joint management between specialist care and primary care
Primary Myelofibrosis (PMF)
Clinical Presentation
Pathogenesis
Diagnosis
Prognosis
Management
Allografting
Hypereosinophilic Syndromes
Introduction
Causes of eosinophilia
Clinical syndromes associated with eosinophilia
Myeloid and lymphoid neoplasms with eosinophilia and abnormalities of PDGFRA, PDGFRB, and FGFR1
Chronic eosinophilic leukaemia – not otherwise specified (CEL-NOS)
Treatment
Mastocytosis
Introduction
Key Points
Classification of Mastocytosis
Systemic Mastocytosis (SM)
Diagnosis
Management of Systemic Mastocytosis
Acute Lymphoblastic Leukaemia
Overview
Clinical Features
Laboratory Diagnosis
Morphology
Classification
Immunophenotyping
Cytogenetics
DNA Analysis
Prognosis, Risk Factors and the Decision to Treat
Prognosis
Risk Factors
The Decision to Treat
Pre-Treatment Investigations
Management
Introduction and Key Questions
Current Trials in ALL
Non-trial Patients
Philadelphia-negative adult ALL
Philadelphia-positive adult ALL
Induction chemotherapy
Supportive Care
Emergencies in Acute Leukaemia
L-Asparaginase Administration and Toxicity
L-asparaginase administration
Management of Anaphylaxis
L-asparaginase – bleeding and thrombosis
CNS disease and intrathecal Chemotherapy
UKALL 14
UKALL 14 Prescription Sheets
COG Trials for High-risk B-ALL
Burkitt Leukaemia/Lymphoma Treatment
Modified OPAL Protocol
Initial Therapy and Prescription Sheets
Consolidation Treatment
Remission Maintenance
Oral Maintenance Therapy
Management of Relapse and Refractory Patients
Palliative Care
CLL, HCL, & LGL Leukaemia
Mature B-cell Leukaemias
Chronic Lymphocytic Leukaemia/Small Lymphocytic Lymphoma (CLL/SLL)
Overview
Clinical Features
Laboratory Diagnosis
Morphology of blood, marrow, and lymph nodes
Immunophenotyping
Cytogenetics
DNA Analysis
Classification, Staging, and Prognosis
Investigations for the New Patient With CLL
Monoclonal B-cell lymphocytosis
Management of B-CLL
Treatment of Newly-Diagnosed Non-trial Patients
Chlorambucil
Fludarabine and Cyclophosphamide
Rituximab
Management of Early Stage B-CLL - Information for general practitioners
Monitoring and Supportive Care
Dose Modifications
Adverse Effects
Supportive Measures
Vaccines
Antiemetics
Blood products
Splenectomy
Monoclonal Antibodies in CLL
Transplantation in CLL
Autologous stem cell transplantation
Relapsed or Refractory Patients
Hairy Cell Leukaemia (HCL)
Clinical and Laboratory Assessment
Prognosis
Management
B-cell Prolymphocytic Leukaemia
Mature T- and NK-Cell Leukaemias
T/NK Large Granular Lymphocyte Leukaemia
Mycosis/Fungoides/Sezary Syndrome
Lymphoma
Non-Hodgkin Lymphoma
Introduction
Classification
Lymphoma MDT
Laboratory Diagnosis
Staging
The Ann Arbor Staging System
Prognosis, Risk Factors, and the Decision to Treat
International Prognostic Index for Aggressive Lymphoma (IPI)
Revised IPI (RIPI)
Enhanced IPI (Derived by National Comprehensive Cancer Network, NCCN)
FLIPI Score for Follicular Lymphoma
Pre-Treatment Investigations for Aggressive NHL
Current Trials in NHL
Management of Non-Trial Patients
Assessment of Response
CNS Directed Therapy
Chemotherapy for Diffuse Large B-cell NHL
CHOP + Rituximab (R-CHOP21)
Modifications to R-CHOP21
Primary CNS Lymphoma
Salvage Protocols
ICE-G and IVE-G +/- Rituximab
R-Hyper-CVAD
Vinorelbine and Gemcitabine for Relapsed T-cell NHL or Hodgkin Lymphoma
Chemotherapy Schedules for Burkitt's and Burkitt-like tumours
CODOX-M /IVAC
R-Hyper-CVAD
Chemotherapy Schedules for Indolent NHL
Chlorambucil
CVP + Rituximab (R-CVP)
FCM and FCM-Rituximab
Maintenance therapy in indolent lymphoma
Management of elderly patients with lymphoma
Stem Cell Grafts in NHL and Hodgkin Lymphoma
NHL subtypes
Follicular Lymphoma (FL)
Diagnosis and Grading
Morphology of the Lymph Node
Other Laboratory Features
Management
Marginal Zone Lymphomas (MZL)
MALT Lymphoma
Management
Anti-tumour treatments
Splenic Marginal Zone Lymphoma
Management
Nodal Marginal Zone Lymphoma
Mantle Cell Lymphoma (MCL)
Management
Diffuse Large B-Cell Lymphoma (DLBCL)
Management
Mediastinal Large B-Cell Lymphoma
Anaplastic Large Cell Lymphoma (ALCL)
Management
Peripheral T-Cell Lymphoma (PTL)
Management
Burkitt Lymphoma/Leukaemia
Waldenstrom's Macroglobulinaemia (Lymphoplasmacytoid Lymphoma)
Management
Primary CNS Lymphoma
AIDS-related Lymphoma (ARL)
Hodgkin Lymphoma
Plasma Cell Neoplasms
MGUS
Assessment of M proteins
Low Risk MGUS
Higher Risk MGUS
MGUS Prognosis
Management of MGUS - Information for general practitioners
Smouldering Myeloma
Diagnosis
Prognosis
Guidelines for Follow Up
Multiple Myeloma
Key Points
Current Trials in Myeloma
Clinical Findings
Laboratory and Radiological Findings
Diagnostic Criteria
Prognosis, Risk Factors and the Decision to Treat
Investigations Required for the New Patient Likely to Receive Intensive Treatment
Management
Key Points
Induction therapy
Transplant Eligible
Transplant Ineligible
Thalidomide
Lenalidomide
Bortezomib
Bortezomib, Cyclophosphamide, Dexamethasone (CyBorD)
C thal Dex or thalidomide, cyclophosphamide and dexamethasone
VMP or Bortezomib (Velcade) Melphalan and Prednisone
Thalidomide Melphalan Prednisone (MPT)
Cyclophosphamide plus Dexamethasone
Melphalan plus Prednisone
Vincristine, Adriamycin, and Dexamethasone (VAD)
Etoposide
High Dose Oral Dexamethasone
Idarubicin and Dexamethasone (ZDex)
Monitoring Treatment for Multiple Myeloma
Stem Cell Schedules – Autograft and Allografts
Bisphosphonate Treatment
Complications of Bisphosphonate Treatment
Calcium and Vitamin D Deficiency
Osteonecrosis of the Jaw (ONJ)
Other toxicities
Prescribing IV Bisphosphonate
Pamidronate
Zoledronic acid
Specific Complications of Myeloma
Bony or Nerve Compression Pain
Hypercalcaemia
Spinal Cord Compression
Infections
Renal failure
Plasmacytoma
Solitary Bone Plasmacytoma
Extra Medullary Plasmacytoma
POEMS Syndrome
Amyloidosis
Diagnosis
Management
Heavy Chain Disease
Plasma Cell Leukaemia
Haemophagocytic Lymphohistiocytosis
Primary HLH
Secondary HLH
Diagnosis
Macrophage activation syndrome (MAS)
Treatment
References
Stem Cell Transplantation (SCT)
Introduction, Administration and Quality – SCT
Introduction
Historical Background
Stem Cell Grafting in Christchurch
Publications
Key Events of the Stem Cell Programme in Christchurch
Transplant Activity
Administration
Haematopoietic Stem Cell Transplant Committee
Referral of Patients for Stem Cell Grafts
Stem Cell Accreditation
Foundation for Accreditation of Cellular Therapy (FACT)
Patient Information Websites
Reference Sources for Stem Cell Grafting Information
Quality
Documentation
Indications for SCT
General Principles for Making Transplant Decisions
Information Sources Helpful in Making Transplant Decisions
Summary of Current Indications for SCT at Christchurch
Acute Myeloid Leukaemia
Allogeneic SCT in First Remission
SCT in Second or Subsequent Remissions
Acute Lymphoblastic Leukaemia
SCT in First Remission
Philadelphia-positive ALL
SCT in Relapsed Patients
References
Burkitt Leukaemia/Lymphoma
References
Chronic Myeloid Leukaemia
References
Chronic Lymphocytic Leukaemia
Recommended reading
Myeloma
International guidelines
Autologous transplant as 1st line consolidation
Tandem autologous transplant as 1st line therapy
Up-front or delayed autologous transplant?
2nd autologous transplant in relapsed myeloma following ASCT1
Allogeneic transplant following ASCT for myeloma in 1st remission
Allogeneic transplant for relapsed myeloma
Amyloidosis
Autologous transplantation
Patient selection is crucial
Allogeneic transplantation
Recommended reading
Myelodysplasia
Primary myelofibrosis (PMF) and MF secondary to ET/PRV
Aplastic Anaemia
Lymphoma
Diffuse Large B cell Lymphoma and transformed low-grade lymphoma
Indolent NHL
Hodgkin Lymphoma
Pre-Transplant Patient Assessment
Initial Patient Assessment
Consents for SCT
Conditioning Schedules for SCT
SCT Conditioning
Cyclophosphamide/TBI Conditioning
Busulphan/Cyclophosphamide Conditioning
Cyclophosphamide + ATG Conditioning
Fludarabine/Melphalan/Alemtuzumab Conditioning
Fludarabine/TBI Conditioning
BEAM Conditioning
High Dose Melphalan Conditioning
Acute Myeloid Leukaemia
Standard Allografts
RIC SCTs
MDS
Standard Allografts
RIC SCTs
Acute Lymphoblastic Leukaemia
Standard Allografts
RIC SCTs
Chronic Myeloid Leukaemia
Standard Allografts
RIC SCTs
Chronic Lymphocytic Leukaemia
Non Hodgkin Lymphoma and Hodgkin Lymphoma
Autologous SCT
Standard Allografts
RIC SCTs
Myeloma
Autografts
Standard myeloablative conditioning
Aplastic Anaemia
Intrathecal Therapy and SCT
IT Methotrexate and SCT
Busulphan Dosing
Prevention of Seizures
Busulphan Concentration and Dose Adjustment
Appendices
Cyclophosphamide/MESNA Detailed Schedule
Details of TBI Treatment
Busulphan Administration and Dose Adjustment
BEAM Detailed Schedule
High Dose Melphalan
Cyclophosphamide + ATG Detailed Schedule
Cyclophosphamide
ATG/ALG Guidelines
Test Dose
Administration following test dose
Side Effects
Monitoring of Patient
Contraindications of ALG/ATG Treatment
Infusion of Cellular Therapy Products
Stem Cell Mobilisation
Autologous Stem Cell Mobilisation - Cyclophosphamide/G-CSF
Allogeneic Stem Cell Mobilisation - G-CSF
Autologous Stem Cell Mobilisation - G-CSF Post Chemotherapy
Autologous G-CSF primed Bone Marrow Harvest
Anticoagulation during Stem Cell Harvest
Allogeneic Transplants
Introduction
The HLA system
Conventional Myeloablative Allografts
Conventional Myeloablative Protocols
Infection Prophylaxis
GvHD Prophylaxis
Reduced Intensity Conditioning (RIC) Allografts
Introduction
RIC Protocols
Infection Prophylaxis
GvHD Prophylaxis
Chimerism Analyses
GvHD Management
Post Transplant Donor Lymphocyte Infusions (DLI)
Definition of Disease Progression
Guidelines for post-transplant management of patients in the absence of GvHD
DLI Decision-making Guidelines for High Risk Patients without GvHD and off all Immunosuppression
Work-Up Prior to DLI
Doses, Collection and Administration of DLI
Further Reading
Myelosuppression Post RIC SCT/DLI
Donor Searches
Sibling Donor Searches
Extended Family Searches (EFS)
One Antigen Mismatched Related SCT
Unrelated Donor (MUD) Searches
Termination of MUD Search
Family Mismatched SCT Donor Search
Donor Selection Assessment and Consent
Selection of the Donor
Donor Assessment for Allograft - Standard or RIC
Donor Consent
Donor Follow-up
If the Donor is a Minor or a Mentally Incompetent Adult
Allogeneic Bone Marrow or Peripheral Blood Harvest and Infusion
Donor Hospital Admission
Donor Bone Marrow Harvest
Donor Peripheral Blood Harvest
Cord Blood Transplantation (CBT)
Historical Aspects
Indications for Cord Blood Transplantation
Fuller Information about Cord Blood Transplants
Procedure for Harvest of Related Cord Blood Stem Cells
Transplant Schedules
Autologous Transplants
Autologous Stem Cell Harvest and Infusion
Autologous Haematopoietic Stem Cell Harvest – Peripheral Blood and Bone Marrow
Bone Marrow Harvests
Peripheral Blood Stem Cell Harvests
Autologous Bone Marrow Harvest and Cryopreservation
Peripheral Blood Stem Cell Harvesting and Mobilisation Protocols
General Comments
Peripheral Blood Stem Cell Mobilisation Protocols
G-CSF Primed Bone Marrow Harvests
Use of Fresh (Non-cryopreserved) Bone Marrow in Autologous BMT
Overnight Storage of PBSC Harvest
Transplant Schedules
Discharge and Follow Up
Discharge to Other Centres
Autologous Patients
Allogeneic Patients
Shared Protocols and Documentation
Post-Transplant Follow-Up
Re-referral Criteria
Contact Us
Complications of SCT
Graft versus Host Disease (GvHD)
Introduction
Acute Graft Versus Host Disease (aGvHD)
Clinical Features and Grading of Severity
Pathogenesis of Acute GvHD
Diagnosis of acute GVHD
Initial Management of Acute GvHD
Steroid tapering
What dose of steroid?
When to start 2nd line treatment
Management of steroid-refractory acute GvHD
Which 2nd line treatment to choose
Further reading
Supportive Care
Skin
Gastro-intestinal
Maintenance of Adequate Nutritional Status
Chronic GvHD (cGvHD)
Clinical Features
Pathogenesis
Diagnosis and Grading and Severity Assessment
Histology of cGvHD
Management
Localised cGvHD
1st line therapy of cGvHD
2nd line and beyond therapy of chronic GvHD
Results of an EBMT survey on 1st and 2nd line therapy of chronic GvHD
Prognosis of cGvHD
Pulmonary GvHD
Clinical symptoms
Diagnosis
Differential diagnosis
Grading of pulmonary GvHD
Lung function score
Prognosis
Management
Monitoring
Essential reading
Management of oral chronic GVHD
Diagnosis
Assessment and Grading
Management
Further Reading
Veno Occlusive Disease of the Liver (VOD)
Pathogenesis
Clinical Features and Diagnosis
Grading of VOD
Prognosis
Management of VOD
Bacterial Infection in SCT
Viral infection in SCT
Hepatitis B
CMV
EBV
Toxoplasma
Infusion-related Reactions in HCT
Introduction
Adverse Reactions (AR)
References
Microbial contamination of cellular therapy products
Transplant Associated Microangiopathy (TAM)
Diagnosis
Pathophysiology
Prognosis
Management
Engraftment failure
Introduction
Engraftment and Chimerism
Approach to the Patient with Graft Failure
Management of Graft Failure
Late Effects Screening after Allogeneic Transplant
Late follow-up of transplant survivors - summary for referring physicians and GPs
Long term Complications and Follow-up
Cancer Screening in HCT Survivors
Vaccination Prophylaxis post-SCT
Stem Cell Transplants - Information for patients
Information about autologous transplants
Information about allogeneic transplants
Resources
Information for General Practitioners
Essential thrombocythaemia - joint management between specialist care and primary care
Management of Early Stage B-CLL - Information for general practitioners
Primary polycythaemia - joint management between specialist care and primary care
Splenectomy Management
Management of MGUS - Information for general practitioners
Information for Patients
Aplastic Anaemia Patient Information Booklet
Chemotherapy Drugs - Patient Information Leaflets
Ovarian Tissue Storage Information
Patient Information Websites
Reviews, Feedback, and Document Control
Managing Unscheduled Updates to the documentation
Managing Scheduled Reviews of the documentation
Archive Process
Review Schedule
Release Notes
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