1. Hematopoietic Database and Manual
Changes made in 2014

2. Starting in 2014, there will be only one Hematopoietic Database
Starting in 2014, there will be only one Hematopoietic Database. It will cover all of the hematopoietic diseases diagnosed from Jan. 1, forward.
Although there were changes to the MP rules, SEER is NOT requiring a review of cases already coded.

3. Summary of Changes
All Hodgkin Lymphomas ( ) had primary site C77._ added in the primary site column. Although rare, HD can occur in extranodal sites. [C77._ is the default site.]
Specific grades were added to many histologies (same as found in the 2010 Heme DB).
All Obsolete codes, marked as [OBS], are effective as obsolete as of Jan. 1, [Some were eff. in 2012.]
A majority of changes were the correction of typographical errors; others include the addition of alternate histology names or the [OBS] indicator.
There are some rule changes in the PH modules of the Manual.

4. Types of Changes Changes to the Hematopoietic Database
Changes to what is considered SAME vs NEW primary
Changes to what are considered Transformations of certain histologies
Change in Reportability
Changes to the Hematopoietic Manual

5. Summary of changes in what is SAME vs NEW primary
These changes may affect case counts (Incidence):
For all [OBS] codes, the new (‘referred to’) code should always be the SAME primary. This was not always the case, and has been corrected in the 2014 database.
Therapy-related myeloid leukemia (9920) and Therapy-related MDS [OBS] (9987, see code 9920) should have no SAME primaries other than each other.
Chronic myeloproliferative disease, NOS [OBS] (9960) was found to have errors in the SAME primary list and in the transformations. These have been corrected; 9960 now has the SAME primaries and transformations as 9975 (Myelodysplastic / myeloproliferative neoplasm, unclassifiable).
Again, SEER is not requiring registries to review existing cases. KCR will evaluate how many cases may be affected by these rule changes and identify the cases to be reviewed by facility. We will share these with you, and ask you to review and delete cases where the rules now say they are the SAME primary. There appear to be too many cases to review which are one primary, but might be two primaries if certain other conditions existed at the time of diagnosis.

6. Summary of changes in what is SAME vs NEW primary
Myelodysplastic diseases (9980–9986, ) should always be the SAME primary.
Follicular lymphomas (9690, 9691, 9695, 9698) are always the SAME primary.
For some histologies, additional SAME primaries were added which were left out of the 2010 release.
There is a Table in the handout for this training which contains all of these changes that I am describing to you.

7. Table of SAME Primary: additions and deletions (see handout for full Table)
Table 1: Same Primaries (Note: Only those histologies that had changes are in this table)
Histology(ies)
Addition
Deletion
Comments
9590/3
9661/3 [OBS], 9662/3 [OBS], 9675/3 [OBS]
See Same Primaries, 1.f and 1.g
9591/3
9675/3 [OBS]
See code 9675/3
9650/3
9661/3 [OBS], 9662/3 [OBS]
See Same Primaries, 1.a
These are examples of Obsolete terms which are being added as SAME primary to these histologies. Not all additions in the Table are Obsolete, however. A Handout of all additions and deletions to the Hematopoietic database will be posted to the KCR training web site along with these presentations after the live webinars are complete.

8. Number of cases affected in KY by these changes
Review of all Therapy related AML and Therapy related MDS cases to see if a second primary might exist would mean review of 2759 cases in KY.
Review of all Chronic Myeloproliferative Disease cases (9960) would entail review of 613 cases in KY.
Review of all cases where two primaries should be only one involves 48 cases. KCR will ask you to review these situations.

9. Changes in Transformations
The “Transformations” field has been relabeled “Transformations to.” If a chronic neoplasm can transform to an acute/more severe neoplasm, the Heme DB will show the acute neoplasm in the “Transformations to” section.
A new field has been added to the database: “Transformations from.” This field was added to help registrars determine which histologies are chronic and which are acute.
Acute neoplasms have other histologies listed in the “Transformations from” field.
Chronic neoplasms ARE the histologies listed in the “Transformations from” field.

10. Changes in list of Transformations
For some histologies, there were changes in the list of histologies considered ‘Transformations to’.
For example, the histologies that had 9861/3 (Acute Myeloid Leukemia, NOS) listed as a transformation, the additional AML histologies were also added as transformations: 9865/3, 9866/3, 9867/3, 9869/3, 9871/3, 9872/3, 9873/3, 9874/3, 9895/3, 9896/3, 9897/3, 9911/3.

11. Table of changes to Transformations (see handout for full Table)
Table 2: Transformations (Note: Only those histologies that had changes are in this table)
Histology
Addition
Deletion
Comments
9651/3, 9653/3
9680/3
See Malignant Transformations, 1.a
9671/3
9650/3, 9651/3, 9652/3, 9655/3, 9659/3, 9663/3
9675/3 [OBS]
Referred to code 9690/3 transforms to DLBCL (9680/3)
For the histolgies in the leftmost column, additional histologies (shown in 2nd col.) have been added to the ‘Transformations to’ field. On the last line, you see 9675/3 is an Obsolete term. The histology 9680/3 has been added as a Transformation, because 9675 cases should now be coded 9690, and 9690 Transforms to 9680.

12. Changes in list of Transformations
Transformations may be new primaries depending on the application of MP Rules For example, (Mycosis Fungoides) used to have a lot of histologies listed as Transformations.
Further review of 2008 WHO Hematopoietic book confirmed that Mycosis Fungoides (9700/3) has no transformations. Review of the histologies that had been listed as transformations but are now deleted could identify cases where Mycosis Fungoides was also present. If MF was present, this would automatically be a second primary per Rule M17 (previously M16).
Transformations may be new primaries depending on the application of MP Rules For example, 9700 (MF) used to have a lot of histologies listed as Transformations. Now they are all deleted in the database. Before 2014, if you had MF and DLBCL (9680) at the same time, you would have used MP rules to decide if it was one primary or two. Now those rules do not apply, so you would end up at rule M16 and the MF will always be a new primary. You may have missed a case of MF in , but it may be very burdensome to find it now; and this kind of review is not required.

13. Changes in Transformations
Review of all cases involved with changes to their malignant transformations list would entail review of 7033 cases in KY.

14. Change in Reportability
Plasma Cell Neoplasm: This was not listed in the manual but was added in the 2012 manual and is to be removed for 2014.
Plasma cell neoplasm is an umbrella term for various diseases, some reportable others not reportable.
If collected, morpholology would have been coded as 9731/4 or 9734/3. If reviewing these records, see if they were abstracted based on the term “plasma cell neoplasm.” If further studies or workup diagnosed a reportable diagnosis, then that case is maintained in the database; otherwise it should be deleted.

15. Changes in Reportability
Review of all cases abstracted as 9731 or 9734 would entail review of 99 cases in KY.

16. Changes to the Hematopoietic Manual
The 2014 revisions include:
• Rule clarification and revision
• Correction of typos (in both manual and database)
• Simplification of rules and reference to database

17. DEMO of on line Hematopoietic Database