Haematological Malignancies 2

Module details

Title

Haematological Malignancies 2

Type

Specialist

Module code

S-CG-S4

Credits

15

Phase

3

Requirement

Compulsory

Aim of this module

This module will provide the trainees with the knowledge and understanding of the role of genomic testing in the diagnosis, classification, monitoring, risk stratification and management of haematological malignancies. This module will build on the concepts and approaches identified in Haematological Malignancies 1 to develop a more comprehensive understanding of haematological malignancies.

This module will focus on patients with chronic lymphocytic lymphoma (CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS), as exemplars. The module will provide the trainees with the skills to recognise the sample diagnostic pathway, the relevant testing strategies, including NGS, clonality and somatic hypermutation to determine risk stratification. Trainees will also appreciate the requirements for integrated reporting with other specialties for SIHMDS compliance.

Training activities

Assessments

Complete 3 Case-Based Discussions

Complete 3 DOPS or OCEs

Direct Observation of Practical Skills Titles

• Risk stratify a patient with CLL, plasma cell dyscrasia, lymphoma, or MDS on the basis of molecular investigations.
• Produce a final report, including the definitive diagnosis of haematological disorders, including the WHO classifications.
• Interpret a case which has been analysed by NGS which requires multiple variant interpretation.
• Interpret a molecular assay for CLL, plasma cell dyscrasias, lymphoma, or MDS.
• Perform an examination audit.
• Review EQA performance for a scheme and present the findings at a lab meeting.

Observed Clinical Event Titles

• Discuss a patient result with another healthcare professional for CLL, plasma cell dyscrasia, lymphoma, or MDS.
• Present a CLL, plasma cell dyscrasia, lymphoma, or MDS case at a multidisciplinary team.
• Raise an ISO finding at a quality meeting.
• Present findings of an incident investigation at a quality meeting.

Learning outcomes

Activities

1. Attend a multidisciplinary team meeting where patient results are discussed and treatment plans devised to appreciate the role of cancer genomics in the patient pathway.
2. Observe histopathological processing of samples for molecular analysis including IHC, and the analysis by a histopathologist to appreciate the sample pathway and processing requirements.
3. Attend a haematological malignancy clinic to appreciate the patient experience of investigation and treatment for a haematological malignancy.

Learning outcomes

On successful completion of this module the trainee will be able to:

1. Describe the underlying pathogenesis of chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS).
2. Classify heterogeneous myeloid and lymphoid malignancies using international guidelines.
3. Evaluate the role of molecular genetic analysis for sub-classification of disorders.
4. Determine the laboratory approaches for the diagnosis, classification and prognosis of chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS).
5. Summarise the clinical management and treatment approaches applicable to chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS).
6. Critically Evaluate the methods available for monitoring of residual disease including molecular genetic approaches and multi-parametric flow cytometry selecting the most appropriate technique for each disorder.

Indicative content

• The pathogenesis (including underpinning genomic mechanisms) of chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS).
• The clonal nature of haematological malignancies and development of resistant clones during treatment.
• Classification of myeloid malignancies according to relevant WHO guidelines.
• Classification of disorders according to molecular genetic investigations – increasing role of molecular genetic and cytogenetic analysis, eg. high grade B cell lymphoma – MYC, BCL2, BCL6.
• The importance of molecular genetic and cytogenetic data to provide prognostic information that would influence treatment decisions.
• An understanding of age related clonal haematopoiesis with regard to the molecular diagnosis of myelodysplastic syndromes.
• Current laboratory pathways and international guidelines for diagnosis of myeloid and lymphoid malignancies (BCSH, ELN, WHO).
• Characteristic morphology and immunophenotype of MDS, CLL and large B cell lymphomas Flow cytometry techniques and approaches.
• Immunohistochemistry techniques and approaches, use of FISH and G-banding techniques
• DNA and RNA extraction (including FFPE and fresh material).
• A range of single gene mutation assessment procedures (eg Sanger sequencing, allele specific PCR, pyrosequencing, high resolution melt analysis, fragment analysis, droplet PCR and others).
• RT-PCR for fusion transcripts.
• Lymphoid clonality (IG gene rearrangement) approaches to aid the diagnosis of lymphoid malignancies. The sensitivity and specificity of these techniques.
• Role of next generation sequencing for multi-gene analysis including both DNA and RNA approaches.
• Role of array CGH.
• Use of bioinformatic tools to analyse data including international resources (eg COSMIC) Interaction of multiple gene abnormalities and into prognostic algorithms.
• Current approaches to treatment of chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and myelodysplastic syndromes (MDS), including chemotherapy, immunotherapy, targeted therapy and stem cell transplant.
• Importance of clinical trials.
• Importance of and procedures for monitoring residual disease during treatment.