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 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 B6
 Assessment of New Admissions to B6
 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
 Invasive Procedures
 Fertility Preservation
 Supportive Care
 eviQ
 B6 exercise guide
 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 and Nutritional Supplements
 Level 2 - Enteral nutrition
 Level 3 - Parenteral nutrition
 Safe Eating and Low Immunity Diet Guidelines
 Nutrition support for patients undergoing an Allogeneic Stem Cell Transplant
 Cultural Considerations for Nutrition Support
 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 B6
 Protective Isolation
 Purpose
 Associated Documents
 Definitions
 Hand Hygiene
 Single Rooms
 Clothing
 Visitors
 Aprons and gowns
 Masks
 B6 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
 Vaccination for Myeloma Patients
 Treatment of Infection in Haematology Patients
 Management of the Septic Immunosuppressed Patient
 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
 Medication Information for Patients
 Prescription Charts
 Individualised Template
 Aplastic Anaemia
 Acute Lymphoblastic Leukaemia
 Chronic Lymphocytic Leukaemia
 Hairy Cell Leukaemia
 Acute Myeloid Leukaemia
 Intrathecal Chemotherapy
 MDS
 Myeloma
 Non-Hodgkin Lymphoma
 Rituximab - any indication
 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
 Intrathecal Chemotherapy Bookings
 Flowchart: Organising Intrathecal Chemotherapy
 Method of Lumbar Puncture
 Examination of CSF
 High-Dose Methotrexate
 Monoclonal Antibodies
 Rituximab
 Alemtuzumab
 Obinuzumab
 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
 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 B6
 Ordering of Blood Products
 Collection and Administration of Blood Transfusions
 Issuing Blood Products to B6
 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
 Transfusion Support Recommendations for ABO-Incompatible HPC Transplantation.
 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-associated Circulatory Overload
 Pathophysiology
 Clinical Features
 Investigations
 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
 Intravenous Immunoglobulin (IVIG) and Evogam (S/C)
 Indications for IVIG 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
 Blood banking issues with Anti-CD38 and CD47 monoclonal antibodies
 Anti-CD38 Antibodies (Daratumumab)
 Effect on Serologic Testing
 Management
 Anti-CD47 Antibodies
 Effect on Serologic Testing
 Management
 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
 Administration and Monitoring
 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 – 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
 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
 Advate
 Adynovate (extended half-life rFVIII)
 Plasma Derived Factor VIII
 Biostate - CSL FVIII
 Recombinant Factor IX
 Rixubis
 Alprolix (extended half-life FIX)
 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 New AML Patients
 Management of AML
 Introduction and Key Questions
 Current Trials in AML
 Supportive Care
 Emergencies in Acute Leukaemia
 AML 19
 AML (other than APML) comparisons
 AML 19 Trial Information
 Remission Criteria
 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
 Hyperleucocytosis
 Acute Promyelocytic Leukaemia
 Overview
 Clinical Features
 Laboratory Diagnosis
 Prognosis and the Decision to Treat
 Pre-Treatment Investigations
 Management
 AML19 APML
 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, PV, ET, PMF, CEL-NOS, Mastocytosis
 Introduction
 Chronic Myeloid Leukaemia - BCR-ABL Positive (CML)
 Clinical Findings
 Investigation of Suspected CML
 Morphology
 Prognostication
 Treatment
 Management of Leucostasis
 Management of CP CML
 Treatment of AP and BP CML
 Monitoring and Response
 Response Definitions, Treatment Goals and Failures
 Management of Suboptimal Response, Treatment Failure, and Loss of Response
 Monitoring and Management of Effects/Toxicity
 Pregnancy and TKI Therapy
 Treatment-free Remission – Stopping TKI Therapy
 Further Reading
 Chronic Neutrophilic Leukaemia (CNL)
 Polycythaemia Vera (PV)
 Diagnostic Criteria
 Clinical Assessment for Raised Hb
 Investigation of Suspected PV
 Treatment
 Response Assessment
 Referral to GP for Shared Care
 PV Refractory or Intolerant Hydroxyurea
 Long-term Outcomes in PV and Management of Transformation
 Further Reading
 Essential Thrombocythaemia (ET)
 Diagnostic Criteria
 Management
 Referral to GP for Shared Care
 Hydroxyurea-Refractory and -Intolerant ET
 Long-term Outcomes in ET and Management of Transformation
 Further Reading
 Primary Myelofibrosis (PMF)
 Diagnostic Criteria
 Prognosis
 Management
 Allografting
 Further Reading
 Eosinophilia
 Causes of Eosinophilia
 Chronic Eosinophilic Leukaemia – Not Otherwise Specified (CEL-NOS)
 Diagnostic Criteria for CEL
 Prognosis and Management of CEL-NOS
 Idiopathic Hypereosinophilic Syndrome (HES)
 Myeloid and Lymphoid Neoplasms with Eosinophilia and Abnormalities of PDGFRA, PDGFRB, FGFR1, or with PCM1-JAK2
 Treatment
 Further Reading
 Mastocytosis
 Classification
 Systemic Mastocytosis (SM)
 Diagnostic Criteria for SM
 Management
 Further Reading
 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 for New ALL and Burkitt's Lymphoma Patients
 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
 Management of Anaphylaxis
 L-asparaginase – bleeding and thrombosis
 AALL1732 Document
 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
 Bendamustine and Rituximab
 Obinutuzumab and Chlorambucil
 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
 Treatment of Lymphoma
 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
 Vinorelbine and Gemcitabine for Relapsed T-cell NHL or Hodgkin Lymphoma
 Chemotherapy Schedules for Burkitt's and Burkitt-like tumours
 CODOX-M /IVAC
 Chemotherapy Schedules for Indolent NHL
 Bendamustine + Rituximab
 CVP + Rituximab (R-CVP)
 Chlorambucil
 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)
 Post-transplant lymphoproliferative disorders (PTLD)
 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
 Introduction
 Clinical features
 Diagnosis
 Evaluation of organ involvement
 Management
 Further reading
 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
 High-risk myeloma
 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
 Geriatric Comprehensive 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
 Administration and Monitoring
 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
 Reporting Data to International Registries
 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
 Summary of Updates
 September 2023
 June 2023
 January 2023
 2022
 November 2022
 September 2022
 August 2022
 June 2022
 May 2022
 February 2022
 2021
 December 2021
 September 2021
 July 2021
 June 2021
 May 2021
 March 2021
 2020
 December 2020
 November 2020
 August 2020
 July 2020
 May 2020
 April 2020
 March 2020
 February 2020
 January 2020
 2019
 December 2019
 November 2019
 October 2019
 September 2019
 August 2019
 July 2019
 June 2019
 May 2019
 March 2019
 February 2019
 January 2019
 2018
 December 2018
 November 2018
 October 2018
 September 2018
 August 2018
 July 2018
 June 2018
 April 2018
 March 2018
 February 2018
 January 2018
 2017
 December 2017
 November 2017
 October 2017
 September 2017
 August 2017
 July 2017
 June 2017
 May 2017
 April 2017
 March 2017
 January 2017
 2016
 December 2016
 November 2016
 October 2016
 September 2016
 August 2016
 July 2016
 June 2016
 May 2016
 April 2016
 March 2016
 February 2016
 2015
 November 2015
 September 2015
 July 2015
 May 2015
 April 2015
 March 2015
 January 2015
 2014
 December 2014
 November 2014
 October 2014
 September 2014
 August 2014
 June 2014
 May 2014
 April 2014
 March 2014
 February 2014
 January 2014
 2013
 December 2013
 November 2013
 October 2013
 September 2013
 August 2013
 July 2013
 June 2013
 May 2013
 April 2013
 March 2013
 February 2013
 2012
 December 2012
 November 2012
 October 2012
 September 2012
 July 2012
 June 2012
 May 2012
 April 2012
 March 2013
 February 2012
 2011
 December 2011
 November 2011
 October 2011
 August 2011
 July 2011
 May 2011
 April 2011
 February 2011
 2010
 November 2010
 October 2010
 August 2010
 July 2010
 June 2010
 April 2010
 January 2010
 2009
 December 2009
 August 2009
 July 2009
 June 2009
 April 2009
 January 2009
 2008
 November 2008
 October 2008
 September 2008
 August 2008
 July 2008
 March 2008
 February 2008
 October 2007
|
|