Diagnosis and disease phase assessment

Minimum established tests include:

• medical examination including documenting spleen size
• real-time quantitative RT-PCR test to detect and measure the level of BCR-ABL1 on the international scale
• biochemistry screen including liver function tests, electrolytes, renal function tests, urate, lipase and amylase, BSL
• HIV, hepatitis B and hepatitis C serology

Investigations that should be done in most circumstances:

• bone marrow aspiration including cytogenetics, immunophenotyping/flow cytometry and morphology (exceptions can be made for frail or very elderly patients)
• fasting lipids (not essential if the patient will receive frontline imatinib)
• chest x-ray (not essential for young, healthy patients)

For patients who may be at high risk of vascular disease, additional tests are recommended before treatment with a second-generation tyrosine kinase inhibitor (TKI). These include ankle brachial index, Doppler study of neck and leg arteries and echocardiogram.

Genetic testing is not relevant for CML

Treatment planning

The treating haematologist should discuss and develop a treatment plan with the patient within 2 weeks of completing investigations.

Research and clinical trials

Consider enrolment where available and appropriate. See the OCP resources appendix and relevant steps for clinical trial resources relevant to CML.

Communication

The lead clinician’s¹ responsibilities include:

• discussing a timeframe for diagnosis and treatment options with the patient and/or carer
• explaining the role of the multidisciplinary team where indicated in treatment planning and ongoing care
• encouraging discussion about the diagnosis, prognosis, advance care planning and palliative care while clarifying the patient’s wishes, needs, beliefs and expectations, and their ability to comprehend the communication
• providing appropriate information and referral to support services as required
• communicating with the patient’s GP about the diagnosis, treatment plan and recommendations.

Checklist

• Diagnosis has been confirmed
• Performance status and comorbidities recorded
• Patient options and recommendations provided to the patient and/or carer
• Clinical trial considered
• Supportive care needs assessed and referrals to allied health services actioned as required
• Referral to support services (e.g. Cancer Council, Leukaemia Foundation)
• Treatment costs discussed with the patient and/ or carer as appropriate

Timeframe

Investigations should generally be completed within 2 weeks.

1 Lead clinician – the clinician who is responsible for managing patient care. The lead clinician may change over time depending on the stage of the care pathway and where care is being provided.