Hima Darapu, MD Princeton Baptist Medical Center Baptist Health systems Alabama

 Chronic Lymphocytic Leukemia ( CLL) is a monoclonal disorder charecterized by progressive accumulation of functionally incompetent lymphocytes.  Immunophenotyping is by Flow cytometry.  To confirm the presence of clonal B-lymphocytes expressing CD5, CD20( dim), CD23.

 To assess the compliance of performing and documentation of the baseline flow cytometry test for CLL pts.  To come up with a method to improve the care by timeliness completion of flow cytometry for a baseline for future records and or for comparision if needed.

 Due to distinct pattern of protein antigens expressed in CLL, flow cytometry should be performed in order to confirm the diagnosis, correctly characterize the pathological cells and determine prognosis.

 Type of study: Restrospective chart review  Patient population: Review of Princeton Baptist Health System’s cancer registry data was performed to identify all patients aged 18 years and older with a diagnosis of CLL from  Data elements: Patient had baseline flow cytometry performed. Documentation of flow cytometry results in patient chart Reason for not performing/documenting baseline flow cytometry Baseline Flow cytometry refers to testing that was performed at the time of diagnosis or prior to initiating treatment.

Total number of CLL patients at Princeton Baptist Medical center from 2010 to 2014 N= 45 Total number of CLL patients at Princeton Baptist Medical center from 2010 to 2014 N= 45 Patients omitted N= 6 Patients further evaluated N= 39 Follow up at a different hospital Flow cytometry performed N= 39 Documentation of flow cytometry in patient chart N= 34 No documentation of flow cytometry in patient chart N= 5 Reason for no documentation Pt on Palliative care N=1 No reason mentioned for no documention N= 4

 Between 2010 to 2014, 45 patients were diagnosed with CLL. 6 patients were excluded based on our exclusion criteria(no follow up)  Of the 39 patient, 100% of them had flow cytometry performed.  Of the 39 patients, 88% of the patients had documented flow cytometry results in the chart.  10% of patients had no documention of flow cytometry results ( with no reasons documented for failure of documentation)  Limitations of the study: sample size.

 Rate of performance of flow cytometry is 100% and rate of documentation at our cancer center is 88%.  Physician education and reminders to providers in the patients charts and by staff.  Repeat study from 2015 to 2018 to assess success of implemented changes and education efforts.

 DiGiuseppe JA, Borowitz MJ. Clinical utility of flow cytometry in the chronic lymphoid leukemias. Semin Oncol Feb;25(1):6-10  American Society of Hematology, Physician Consortium for Performance Improvement®. Hematology physician performance measurement set. Washington (DC): American Society of Hematology (ASH); 2014 Nov. 17 p  National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: non-Hodgkin's lymphoma. V [slide set]. Fort Washington (PA): National Comprehensive Cancer Network (NCCN); 445 p.

 Judy Lang, Cancer Registry Coordinator  Dr. Katisha Vance