Module information
Details
- Title
- Haematological Malignancies 2
- Type
- Specialist
- Module code
- S-CG-S4-2
- Credits
- 15
- 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 acute lymphoblastic leukaemia (ALL), 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.
Work-based content
Competencies
| # | Learning outcome | Competency | Action |
|---|---|---|---|
| # 1 | Learning outcome 1,2 |
Competency
Interpret haematological assays to inform testing strategies, to include:
|
Action View |
| # 2 | Learning outcome 2,3 |
Competency
Select the appropriate testing pathway for patients with a suspected diagnosis of the following conditions:
|
Action View |
| # 3 | Learning outcome 4,5,6 |
Competency
Analyse, interpret and draft a clinical report for appropriate assays for suspected/confirmed plasma cell dyscrasias |
Action View |
| # 4 | Learning outcome 4,5,6 |
Competency
Analyse, interpret and draft a clinical report for risk stratification and treatment for CLL, to include:
|
Action View |
| # 5 | Learning outcome 4,5,6 |
Competency
Analyse and interpret the results of lymphoid clonality assessment (Ig and TR gene rearrangements) to aid the diagnosis of suspected mature lymphoid malignancies |
Action View |
| # 6 | Learning outcome 4,5,6 |
Competency
Analyse, interpret and draft a clinical report for the detection of IGH/TR for MRD monitoring of lymphoid malignancies. |
Action View |
| # 7 | Learning outcome 3,4,5,6 |
Competency
Analyse, interpret and draft a clinical report for testing to inform urgent treatment decisions in lymphomas, to include:
|
Action View |
| # 8 | Learning outcome 4,5,6 |
Competency
Analyse, interpret and draft a clinical report for testing in the diagnosis of other lymphomas to include:
|
Action View |
| # 9 | Learning outcome 4,5,6 |
Competency
Interpret and draft a clinical report for NGS for the diagnosis and treatment decisions of lymphoid disorders |
Action View |
| # 10 | Learning outcome 4,5,6 |
Competency
Analyse, interpret and draft a clinical report for diagnosis and risk stratification of ALL, to include:
|
Action View |
| # 11 | Learning outcome 3,4,5,6 |
Competency
Attend and present a case to be discussed and reviewed in a multidisciplinary team meeting with other healthcare professionals |
Action View |
| # 12 | Learning outcome 3,4,5,6,7 |
Competency
Assist with the preparation of SIHMDS integrated reports for haematological malignancies |
Action View |
| # 13 | Learning outcome 4,5,6,8 |
Competency
Assist in the preparation and take part in ISO surveillance visit for haematological malignancies |
Action View |
| # 14 | Learning outcome 4,5,6,8 |
Competency
Investigate an incident and perform a route cause analysis, including document findings and outcomes |
Action View |
| # 15 | Learning outcome 4,5,6,8 |
Competency
Perform and document a validation or verification for haematological malignancies |
Action View |
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 ALL 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 ALL.
- 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 ALL.
- Present a CLL, plasma cell dyscrasia, lymphoma, or ALL 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
| # | Learning outcome |
|---|---|
| 1 | Identify the main clinical, morphological and phenotypical features of CLL, plasma cell dyscrasias, B cell lymphomas (low and high grade) and ALL. |
| 2 | Select the relevant testing strategy for commonly referred haematological. |
| 3 | Evaluate the urgency of testing for particular haematological malignancies to inform management decisions. |
| 4 | Analyse, interpret and prepare interpretive reports for common haematological malignancies, including results for somatic variants, clonality, and somatic hypermutation. |
| 5 | Interpret the associated IQC and EQA of the laboratory tests for investigation of haematological malignancies. |
| 6 | Practice with the relevant specialties for the diagnosis, monitoring and management of haematological malignancies. |
| 7 | Summarise the information and findings of investigations of haematological malignancies for integrated reporting in compliance with the requirements of an integrated diagnostic service. |
| 8 | Apply the standards of ISO:15189 accreditation and compliance including root cause analysis (RCA) and verfication/validation requirements for cancer genomics. |
Academic content (MSc in Clinical Science)
Important information
The academic parts of this module will be detailed and communicated to you by your university. Please contact them if you have questions regarding this module and its assessments. The module titles in your MSc may not be exactly identical to the work-based modules shown in the e-portfolio. Your modules will be aligned, however, to ensure that your academic and work-based learning are complimentary.
Learning outcomes
On successful completion of this module the trainee will be able to:
- Describe the underlying pathogenesis of chronic lymphocytic lymphoma (B CLL), plasma cells dyscrasias, B cell lymphomas (low and high grade) and acute lymphoblastic leukaemia (ALL).
- Classify heterogeneous lymphoid malignancies using international guidelines.
- Evaluate the role of molecular genetic analysis for sub-classification of disorders.
- 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 acute lymphoblastic leukaemia (ALL).
- 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 acute lymphoblastic leukaemia (ALL).
- 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 acute lymphoblastic leukaemia (ALL).
- The clonal nature of haematological malignancies and development of resistant clones during treatment.
- Classification of lymphoid malignancies according to relevant guidelines e.g. WHO, ICC.
- 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.
- Current laboratory pathways and international guidelines for diagnosis of lymphoid malignancies (BSH, ELN, WHO).
- Characteristic morphology and immunophenotype of ALL, 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 relevent 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.
- Translocations giving rise to MYC deregulation through IG-MYC.
- 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 and WGS.
- 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 acute lymphoblastic leukaemia (ALL), including chemotherapy, immunotherapy, targeted therapy and stem cell transplant.
- Importance of clinical trials.
- Importance of and procedures for monitoring residual disease during treatment.
Clinical experiences
Important information
Clinical experiential learning is the range of activities trainees may undertake in order to gain the experience and evidence to demonstrate their achievement of module competencies and assessments. The list is not definitive or mandatory, but training officers should ensure, as best training practice, that trainees gain as many of these clinical experiences as possible. They should be included in training plans, and once undertaken they should support the completion of module assessments and competencies within the e-portfolio.
Activities
- 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.
- Observe histopathological processing of samples for molecular analysis including IHC, and the analysis by a histopathologist to appreciate the sample pathway and processing requirements.
- Attend a haematological malignancy clinic to appreciate the patient experience of investigation and treatment for a haematological malignancy.