Test/procedures in the initial work-up of a patient with AML
Test/procedure . | General practice . | Clinical trial . |
---|---|---|
Tests to establish the diagnosis | ||
Complete blood counts and differential count | Yes | Yes |
Bone marrow aspirate | Yes | Yes |
Bone marrow trephine biopsy | Optionalf | Optionalf |
Immunophenotyping | Yes | Yes |
Cytogenetics | Yes | Yes |
RUNX1-RUNX1T1, CBFB-MYH11, PML-RARA, or other gene fusion screening | Optionalg | Optionalg |
Additional tests/procedures at diagnosis | ||
Demographics and medical historya | Yes | Yes |
Performance status (ECOG/WHO score) | Yes | Yes |
Analysis of comorbidities | Yes | Yes |
Biochemistry, coagulation tests, urine analysisb | Yes | Yes |
Serum pregnancy testc | Yes | Yes |
Information on oocyte and sperm cryopreservation | Optionalh | Optionalh |
Eligibility assessment for allogeneic HSCT | Yesi | Yesi |
Hepatitis A, B, C; HIV-1 testing | Yes | Yes |
Chest x-ray, 12-lead ECG; echocardiography (on indication) | Yes | Yes |
Lumbar punctured | No | No |
Biobankinge | Optionalj | Yes |
Prognostic/predictive marker assessment | ||
NPM1, CEBPA, FLT3 gene mutation | Optionalk | Yes |
WT1, RUNX1, MLL, KIT, RAS, TP53, TET2, IDH1 gene mutation | No | Investigational |
ERG, MN1, EVI1, BAALC gene expression | No | Investigational |
Detection of minimal residual disease | No | Investigational |
Test/procedure . | General practice . | Clinical trial . |
---|---|---|
Tests to establish the diagnosis | ||
Complete blood counts and differential count | Yes | Yes |
Bone marrow aspirate | Yes | Yes |
Bone marrow trephine biopsy | Optionalf | Optionalf |
Immunophenotyping | Yes | Yes |
Cytogenetics | Yes | Yes |
RUNX1-RUNX1T1, CBFB-MYH11, PML-RARA, or other gene fusion screening | Optionalg | Optionalg |
Additional tests/procedures at diagnosis | ||
Demographics and medical historya | Yes | Yes |
Performance status (ECOG/WHO score) | Yes | Yes |
Analysis of comorbidities | Yes | Yes |
Biochemistry, coagulation tests, urine analysisb | Yes | Yes |
Serum pregnancy testc | Yes | Yes |
Information on oocyte and sperm cryopreservation | Optionalh | Optionalh |
Eligibility assessment for allogeneic HSCT | Yesi | Yesi |
Hepatitis A, B, C; HIV-1 testing | Yes | Yes |
Chest x-ray, 12-lead ECG; echocardiography (on indication) | Yes | Yes |
Lumbar punctured | No | No |
Biobankinge | Optionalj | Yes |
Prognostic/predictive marker assessment | ||
NPM1, CEBPA, FLT3 gene mutation | Optionalk | Yes |
WT1, RUNX1, MLL, KIT, RAS, TP53, TET2, IDH1 gene mutation | No | Investigational |
ERG, MN1, EVI1, BAALC gene expression | No | Investigational |
Detection of minimal residual disease | No | Investigational |
Including race or ethnicity, family history, prior exposure to toxic agents, prior malignancy, therapy for prior malignancy, information on smoking.
Biochemistry: glucose, sodium, potassium, calcium, creatinine, aspartate amino transferase (AST), alanine amino transferase (ALT), alkaline phosphatase, lactate dehydrogenase, bilirubin, urea, total protein, uric acid, total cholesterol, total triglycerides, creatinine phosphokinase (CPK). Coagulation tests: prothrombin time (PTT), international normalized ratio (INR) where indicated, activated partial thromboplastin time (aPTT). Urine analysis: pH, glucose, erythrocytes, leukocytes, protein, nitrite.
In women with childbearing potential.
Required in patients with clinical symptoms suspicious of central nervous system involvement; patient should be evaluated by imaging study for intracranial bleeding, leptomeningeal disease, and mass lesion; lumbar puncture considered optional in other settings (eg, high WBC).
Pretreatment leukemic bone marrow and blood sample; for further optional storing see section 4.7.
Mandatory in patients with a dry tap (punctio sicca).
Should be performed if chromosome morphology is of poor quality, or if there is typical morphology but the suspected cytogenetic abnormality is not present.
Cryopreservation to be done in accordance with the wish of the patient.
HLA typing and CMV testing should be performed in those patients eligible for allogeneic stem cell transplantation.
Biobanking should also be performed in general practice if at all possible.
Strongly encouraged in AML with normal karyotype.