Objectives
  • To be able to perform specialist assessment, diagnostics, treatment and counselling of patients with leukaemia

  • To understand the molecular and cellular pathology of leukaemia and its relevance for the clinical management of patients

Awareness
  • Recognition of the importance of a multimodality approach to treat patients with leukaemia, including haematology, medical oncology, transfusion medicine and infectious disease specialists, transplant centres, and specialised nursing care

  • Awareness of the different morphological, cytogenetic and molecular entities or subtypes of leukaemia as defined by the WHO classification for the assessment of prognosis and the selection of appropriate treatment

  • Appreciation of the relevant diagnostic procedures, including quality control measures

  • Awareness of risk factors for specific types of leukaemia

  • Recognition of the psychosocial implications of a diagnosis of leukaemia and its treatment

  • Awareness of specific issues on the care of patients that underwent allogeneic stem cell transplantation, including identification and management of graft-versus-host disease and infections in immunosuppressed hosts

Knowledge
  • Familiarity with the indications and the techniques of different diagnostic tools available for the identification of leukaemias (including examination of peripheral blood film morphology, bone marrow aspirates and biopsies, immunophenotyping, cytogenetics, and karyotyping as well as molecular diagnostic techniques—the latter comprising polymerase chain reaction (PCR) or reverse transcriptase (RT)-PCR, fluorescence in situ hybridisation (FISH) and next-generation sequencing (NGS) for the molecular detection of specific chromosomal abnormalities as well as somatic mutations)

  • Familiarity with the techniques to identify potential human leucocyte antigen (HLA)-compatible stem cell or bone marrow donors (siblings and unrelated donors)

  • Familiarity with the identification and the treatment of comorbidities in patients with leukaemia, notably infectious disease complications

  • Knowledge about the indications for chemotherapy, targeted therapy (notably with tyrosine kinase inhibitors and monoclonal antibodies) and stem cell transplantation (allogeneic and autologous), the side effects of these treatments and their therapeutic results

  • Familiarity with the principles of transfusion medicine, adequate red cell and platelet support, and leukapheresis (specifically to treat hyperleukocytosis syndrome, and to collect haematopoietic stem cells from patients in remission or from selected stem cell donors)

  • Familiarity with the diagnosis and the treatment of infections, notably during periods of severe treatment-induced bone marrow failure

  • Knowledge of disease-associated syndromes such as autoimmune cytopenias (eg, autoimmune haemolytic anaemia in chronic lymphocytic leukaemia (CLL))

  • Familiarity with the complications that derive from leukaemia progression and those that are treatment-associated in the context of being familiar with supportive and palliative care strategies

Skills
  • Ability to perform patient history and physical examination

  • Ability to perform bone marrow aspirates and biopsies as well as lumbar punctures to sample cerebrospinal fluid for cytology and other diagnostic techniques

  • Ability to contribute actively to establish a diagnosis of leukaemia with morphological, immunological, cytogenetic and molecular diagnostic techniques, as well as imaging where needed

  • Ability to identify and manage conditions (such as performance status and the patient's clinical condition, concomitant disease, previous treatments) that are important for considering when to start and when to stop treatment or to switch to another therapeutic option

  • Ability to contribute actively in presenting patient cases

  • Ability to identify typical emergencies in leukaemic patients (including hyperleukocytosis syndromes, bleeding due to coagulopathy and/or thrombocytopenia notably in acute promyelocytic leukaemia, septicaemia in patients with neutropenia), and to organise appropriate treatment rapidly

  • Ability to discuss critically the treatment options/recommendations at various stages of disease, ie, at presentation, in patients with disease remission after induction, in leukaemia relapse and in end-of-life care decisions

  • Ability to determine therapy according to molecular marker status where appropriate

  • Ability to prescribe various chemotherapeutic or targeted/immunotherapeutic agents (tyrosine kinase inhibitors and monoclonal antibodies) as well as intrathecal therapy where needed

  • Ability to manage side effects of various chemotherapeutic, immunotherapeutic or targeted agents

  • Ability to provide appropriate supportive care, including red cell and platelet transfusions, antibiotic and antifungal prophylaxis or treatment, and immunoglobulin substitution for hypogammaglobinaemia-associated infections where needed