Haematology audit template
Date of
completion
Name of lead
author/
participants
Specialty
Haematology
Title
An audit of compliance with the BCSH guidelines on the investigation and
management of Mantle Cell lymphoma.
Background
The BCSH has published guidance on the investigation and management of
patients with mantle cell lymphoma. This includes guidance on obtaining a
diagnosis, prognostic scoring and management. This audit will review compliance
of current practice with this guideline.
Aim and
objectives
1. To review whether all essential diagnostic investigations have been
performed.
2. To review whether all patients have been appropriately risk stratified.
3. To review whether patients are being offered appropriate treatment.
Standards
and criteria
Criteria range: 100%, or if not achieved, there is documentation in the case
notes that explains the variance.
Standards
1. Essential investigations

Lymph node excision/adequate core biopsy (not FNAC)
- routine central review by haematopathologist
- immunohistochemistry (CD20, CD5, CD10, CD23, cyclin D1, BCL6,
BCL2)
- Ki67 proliferation index should be recorded at baseline
- molecular studies in atypical cases (atypical morphology, aberrant
phenotype, equivocal cyclinD1 positivity, unusual clinical presentation)
using FISH for t(11;14)

Staging investigations
- CT neck, chest, abdomen and pelvis (involving oral contrast unless
contraindicated)
- Bone marrow aspirate and trephine with immunophenotyping
2. Prognostic score
 the MIPI score or simplified MIPI score should be recorded for all patients
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at diagnosis
3. Patients receiving Rituximab as part of their chemotherapy treatment should
be tested (prior to treatment) for hepatitis B, hepatitis C and, preferably also,
HIV.
4. Appropriate treatment has been commenced according to age and stage
 Stage 1A
- involved field radiotherapy
 Advanced stage
- asymptomatic with indolent presentation (usually splenomegaly and
leukaemia)
o watch and wait
- symptomatic
o clinical trial
o rituximab plus chemotherapy (all patients)
o younger, fitter patients should receive a cytarabine –containing
regimen
o younger, fitter patients should be autografted in 1st remission

Method
Sample selection: all patients diagnosed in the preceding 12 months.
Data to be collected on proforma (see below).
Results
(To be completed by the author)
The results of this audit show the following % compliance with the standards:
% compliance
Essential investigations
Lymph node excision or adequate core biopsy
Staging CT
Staging bone marrow biopsy
Prognostic score recorded (MIPI or sMIPI)
Virology testing
Appropriate treatment commenced
Stage 1A
Involved field radiotherapy
Advanced stage
Asymptomatic and indolent presentation – watch and wait
Symptomatic – rituximab + chemotherapy (all ages)
Younger, fitter patients – cytarabine-containing regimen
Younger, fitter patients – autograft in 1st remission
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Conclusion
(To be completed by the author)
Recommendations for
improvement
Present the result with recommendations, actions, and responsibilities for
action and a timescale for implementation. Assign a person/s responsible to
do the work within a timeframe.
Some suggestions:
 highlight areas of practice that are different
 present findings.
Action plan
(To be completed by the author – see attached action plan proforma)
Re-audit date
(To be completed by the author)
Reference
Guidelines for the investigation and management of mantle cell lymphoma
P. McKay, M. Leach, R. Jackson, G. Cook and S. Rule. British Journal of
Haematology, 2012; 159: 405-426.
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Data collection proforma for the patients with newly diagnosed mantle cell
lymphoma
Audit reviewing practice
Patient name:
Hospital number:
Date of birth:
Consultant:
List of investigations
1
Yes
2
No
3 If no, was there
documentation to
explain the
variance?
Yes/No plus freetext comment
4 Compliant with
guideline based on
Yes from column 1
or an appropriate
explanation from
column 3. Yes/No
Diagnosis & Staging
Lymph node
excision or adequate core biopsy
Staging CT
Staging bone marrow biopsy
Ki67 Recorded
Prognostic score recorded (MIPI or simplified MIPI)
Score documented
Virology testing
Hepatitis B, C (+/- HIV)
Appropriate treatment commenced
Stage 1A
Involved field radiotherapy
Advanced stage
Asymptomatic – watch and wait
Symptomatic – rituximab
+ chemotherapy
Cytarabine- containing regimen
(younger, fitter patients)
Autograft (younger, fitter patients)
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