PATHWAY OPTIONS
There are a number of options, please ensure you select the correct pathway for your sample.
NOTE: if there is a known molecular lesion that requires monitoring please indicate this on the request, use this pathway also to follow up MPAL but please indicate on request.
- Pathway 3A: AML Follow up (standard)
- Pathway 3B: AML follow up (treatment decision)
- Pathway 3C: AML follow up (suspected relapse)
- Pathway 3D: AML blood sample: molecular monitoring
- Pathway 3E: AML follow up post-transplant
Pathway 3A: AML Follow up (standard)
This pathway would be the expected choice for most circumstances. RNA follow up where there is a known molecular MRD marker. Flow cytometry MRD will be performed if suitability has been confirmed on a diagnostic sample (coming soon). Please state MRD marker on request- this can be found on the integrated report on the diagnostic sample.
The following tests will be performed:
- Morphology marrow: URGENT
- Markers: option acute leukaemia marrow URGENT
- Trephine biopsy [immune-stain if indicated] (optional)
- Cytogenetics Standard AML follow up
- OPTION Molecular RNA: known NPM1 lesion
- OPTION Molecular RNA: known inv.16 mutation
- OPTION Molecular RNA: known t(8;21) mutation
- OPTION Molecular RNA: known PML/RARA mutation
- OPTION Molecular other agreed test (specify on request)
- OPTION Flow MRD for selected cases (known suitability)
Pathway 3B: AML follow up (treatment decision)
This pathway is used when an urgent decision that influences treatment is required e.g. on marrow transplant. Flow cytometry MRD will be performed if suitability has been confirmed on a diagnostic sample and no molecular lesion is suitable.
The following tests will be performed:
- Morphology marrow: URGENT
- Markers: option acute leukaemia marrow URGENT
- Trephine biopsy [immune-stain if indicated] (optional)
- Cytogenetic Urgent AML follow up
- OPTION Molecular RNA: known NPM1 lesion
- OPTION Molecular RNA: known inv.16 mutation
- OPTION Molecular RNA: known t(8;21) mutation
- OPTION Molecular RNA: known PML/RARA mutation
- OPTION Molecular other agreed test (specify on request)
- OPTION Flow MRD for selected cases (known suitability)
Pathway 3C: AML follow up (suspected relapse)
Suspected relapse of acute leukaemia requiring full evaluation. Flow cytometry MRD will be performed if suitability has been confirmed on a diagnostic sample and no molecular lesion is suitable.
The following tests will be performed:
- Morphology marrow: URGENT
- Markers: option acute leukaemia marrow URGENT
- Histopathology BM trephine
- Cytogenetics/ FISH: Urgent AML follow up
- Molecular prepare DNA and RNA analyse as indicated
- OPTION Flow MRD for selected cases (known suitability)
Pathway 3D: AML blood sample: molecular monitoring
Use for follow up of AML where a molecular marker request monitoring, e.g. where NPM1 is known to be mutated. Other tests can be performed on request, please indicate on form.
The following tests will be performed:
- OPTION Molecular RNA: known NPM1 lesion
- OPTION Agreed other molecular test (specify on request form)
Pathway 3E: AML follow up post-transplant
Full evaluation of post transplant AML. Panel or molecular testing will not be performed post -transplant samples unless specifically agreed on discussion. DNA/RNA will be stored for specific indications. Flow cytometry MRD can be performed if suitability has been confirmed on a diagnostic sample and no molecular lesion is suitable.
The following tests will be performed:
- Morphology marrow: URGENT
- Markers: option acute leukaemia marrow URGENT
- Histopathology BM trephine
- Cytogenetics Standard AML follow up
- Molecular DNA and RNA: store may activate specific tests on request
- OPTION Flow MRD for selected cases (known suitability)