3.2 Other pre-treatment investigations

3.2 Other pre-treatment investigations

It is important to evaluate and document relevant organ functions (e.g. respiratory, cardiac, hepatic, renal) and physiological robustness using validated assessment tools for all patients, especially older patients (Sorror et al. 2017).

Careful clinical and haematological assessment is required to identify patients in whom the start of chemotherapy could or should be delayed. The presence of an active infection at diagnosis is important to identify.

In addition to a clinical examination, the following investigations/procedures are recommended:

  • coagulation status to detect leukemia-related coagulopathy (Döhner et al. 2017)
  • MRI brain +/– lumbar puncture if central nervous system involvement is suspected
  • CT/PET scan to help assess for extramedullary disease where this is clinically suspected
  • cardiac investigation including an ECHO or a gated heart pool scan in patients being considered for induction therapy
  • human leukocyte antigen (HLA) typing and HLA antibody screening at diagnosis in patients being considered for induction therapy.

Each unit should have a policy about if, and when, HLA typing of available first- and second-degree family members should occur. This policy should be agreed with the allo-SCT unit to which referrals are usually directed.

In patients with adverse or intermediate risk disease, early allo-SCT should be considered (Döhner et al. 2010) and, therefore, a donor search should be carried out as early as possible in accordance with agreed policies of the allo-SCT unit to which referrals are usually directed.