The following guidelines should be considered by physicians when referring patients to the Leukemia/BMT Program:
Patients with acute leukemia, Burkitt's lymphoma and lymphoblastic lymphoma should be considered hematologic emergencies and referred by direct discussion with the Triage Physician or On-Call Staff Physician. A fax referral should not be sent. Call the Program Office directly at 604-875-4863.
Patients who might require blood stem cell transplantation and are 70 years of age or younger and must receive blood products prior to transfer, should receive CMV negative blood products, until their CMV status is known.
Patients suspected of having severe aplastic anemia who must receive blood products should receive CMV negative and irradiated blood products.
All patients who have undergone stem cell transplantation should only receive irradiated blood products.
If a bone marrow examination is done prior to referral to the Leukemia/BMT Program, samples should be taken for routine microscopy, flow cytometry, which is done at Vancouver General Hospital, and cytogenetic analysis and stem cell assays both of which are done at the BC Cancer Agency.
If a patient is 70 years of age or younger and has newly diagnosed multiple myeloma, pulse dexamethasone (40 mg PO daily x 4 days and repeated after a 4-day "rest") and pamidronate 90 mg IV (repeated monthly) are appropriate under most circumstances. However, patients should not receive oral melphalan (i.e., "M+P") until they have been assessed for an autologous bone marrow transplant and have had their stem cells collected.
