2010 Hematopoietic and Lymphoid Neoplasm Project Issues, Timing and Transformations

Changes in classification Reportability MP Rules PH Rules Progression vs Transformation

Issues, Timing and Transformations Changes in classification: What the NHL??? Previously 2 classifications: NHL and HL Based on presence or absence of Philadelphia chromosome Reed-Sternberg cells NHL three categories: Precursor B-cell Mature B-cell Mature T-cell and NK cell

Issues, Timing and Transformations Classification now based on cell lineage Defined by immunophenotype and/or genetic abnormalities Precursor lymphoid neoplasms B lymphoblastic leukemia/lymphoma Term “non-Hodgkin” obsolete

Issues, Timing and Transformations Reportability Update case-finding lists Update reportability algorithms Add Langerhans histiocytosis - all Add other newly reportable Add new WHO terms Use ICD-9-CM casefinding list casefinding/index.htmlhttp://seer.cancer.gov/tools/ casefinding/index.html

Issues, Timing and Transformations MP Rules Rules M1 and M2 Minimal information; single histology Rules M3 - M12 Multiple histologies Single report, multiple histologies Multiple reports, different histologies

Issues, Timing and Transformations Rule M3 Multiple “non-Hodgkin” histologies in a single lymph node or organ considered a single primary “Composite lymphoma” Does not require biopsy of multiple lymph nodes for confirmation Do not query Hemto DB Refer to MP Rules

Issues, Timing and Transformations Rule M4 Hodgkin and non-Hodkin lymphoma in a single lymph node or organ is a single primary Does not require biopsy of multiple lymph nodes for confirmation Do not query Hemto DB Refer to MP Rules

Issues, Timing and Transformations Rule M5 Hodgkin lymphoma and non-Hodgkin lymphoma in two different lymph nodes or organs abstracted as two primaries Lymph nodes may be in same lymph node chain Example: Cervcal LN: Hodgkin lmphoma Inguinal LN: Follicular lymphoma

Issues, Timing and Transformations Rule M6 NOS histology followed by a specific histology; MP calculator states same: single primary Change histology code to specific histology Notify CTR NAACCR M or NAACCR U

Issues, Timing and Transformations Example of M Classical HL (CHL) 9651 Lymphocyte-rich CHL 9652 Mixed cellularity CHL 9653 Lymphocyte-depleted CHL 9659 Nodular lymphocyte predominant CHL 9663 Nodular sclerosis CHL

Issues, Timing and Transformations Rules M7 - M12: Rare Instances Rule M7 Chronic followed by acute histology within 21 days AND one (+) BM is a single primary Probable provisional Dx followed by final Dx Use BM for diagnosis

Issues, Timing and Transformations Rule M8 Both chronic and acute histology within 21 days AND two (+) BM is two primaries One BM = chronic One BM = acute

Issues, Timing and Transformations Rule M9 Both chronic and acute histology within 21 days and BM = single primary Likely ongoing work-up Use most recent (later) diagnosis

Issues, Timing and Transformations Rule M10 Original Dx chronic and subsequent Dx acute (blast) > 21 days is multiple primaries

Issues, Timing and Transformations Rule M11 First Dx is acute; reverts to chronic is one primary Code as acute Follow-back to rule out treatment Follow back for BM

Issues, Timing and Transformations Rule M12 Original Dx is acute; after Rx verts to chronic is two primaries Change from previous rules Use Hemato DB to confirm separate primaries

Issues, Timing and Transformations Primary Site and Histology (PH) Rules Nine Modules Ambiguous terms used to determine reportability, not histology Use PH rules for histology

Issues, Timing and Transformations Module 7: Lymphoma primary site Code primary as BM (C42.1) if BM only is involved Lymphoma in organ and its regional LNs coded to organ site No evidence of lymphoma in LNs and physician suspects organ origin, code to Unknown (C80.9)

Issues, Timing and Transformations Module 8: Histology (multiple) If non-specific and specific, single primary Code to specific Use Hemato DB to confirm same histology (multiplicity calculator)

Issues, Timing and Transformations Module 9: Default Rules Impossible to apply modules 1-8 Inadequate or missing documentation Conflicting reports Conflicting cell phenotypes PH 4-PH 40 do not determine histology use numerically higher code

Issues, Timing and Transformations Progression vs Transformation Understanding progression vs transformation Defining progression and transformation Using the Hemato DB to determine progression vs transformation

Issues, Timing and Transformations Progression: worsening of disease over time Generally chronic Same cell type, function, genetics Change in symptoms, treatment and/or prognosis Ex: smoldering myeloma to frank or “full blown” myeloma

Issues, Timing and Transformations Transformation: change in nature, function or condition Genetic transformation Change in potential or type Ex: PV to AML New primary Need incidence count for both chronic and acute Verify with Hemato DB

Issues, Timing and Transformations Questions? This work was supported by Contract HHSN C between the National Cancer Institute and the Connecticut Department of Public Health.