Current RMA Instruments
| Reasonable Hypothesis SOP | 78 of 2022 |
| Balance of Probabilities SOP | 79 of 2022 |
Changes from previous Instruments
ICD Coding
- ICD-10-AM Codes: C91.1, C91.3, C91.4
Brief description
This SOP covers a group of haematological malignancies of B lymphocytes. This group includes chronic lymphocytic leukaemia and small lymphocytic lymphoma. These are tumours of the same lymphoid cell type and are considered to be a single disease entity that has two clinical presentations. When this disease occurs mostly in the blood stream and bone marrow it is called chronic lymphocytic leukaemia (CLL). When it occurs mostly in the lymph nodes or lymphoid tissue it is called small lymphocytic lymphoma (SLL).
Confirming the diagnosis
This diagnosis is complex and requires specialist opinion based on blood and bone marrow cytology or lymphoid tissue or lymph node histology.
The relevant medical specialist is a haematologist or haematologist oncologist.
Additional diagnoses covered by SOP
- B cell prolymphocytic leukaemia
- chronic lymphocytic leukaemia/small lymphocytic lymphoma
- Chronic lymphatic / lymphoid leukaemia
- Hairy cell leukaemia
Conditions not covered by SOP
- Acute lymphoblastic leukaemia*
- Acute myeloid leukaemia*
- Adult T cell lymphoma/leukaemia* - non-Hodgkin lymphoma SOP
- Chronic myeloid leukaemia*
- Non-Hodgkin lymphoma* apart from small lymphocytic lymphoma
- T cell prolymphocytic leukaemia#
* another SOP applies
# non-SOP condition
Clinical onset
CLL is generally asymptomatic and uncovered by routine blood testing. SLL may present with a lump (enlarged lymph node), which is then biopsied. Clinical onset will generally be at the time of such testing or when the enlarged lymph node was first discovered.
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. The condition is generally regarded as incurable, but typically progresses only slowly, with patients surviving for many years or even decades. The initial management of early stage disease is often simply watchful waiting. Inability to obtain appropriate treatment in that circumstance would not result in a clinical worsening.
Haematological malignancy SOP classifications:
| Name | Included in SOP | Excluded from SOP |
|---|---|---|
Acute Lymphoblastic Leukaemia (B or T cells)
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| Acute Myeloid Leukaemia |
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Mature B-cell Lymphoid Leukaemias and Small Lymphocytic Lymphoma (B cells) |
|
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Chronic Myeloid Leukaemia
|
|
|
Non-Hodgkin lymphoma (T or B cells) |
|
|
Hodgkin’s Lymphoma (B cells)
|
| |
Myeloma
|
|
|