An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 10/16/2025 2:40 AM
Question 20110053
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M10, abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. Two primaries should be accessioned for this case: refractory anemia with excess blasts (RAEB) [9983/3] (a chronic neoplasm), and acute myeloid leukemia [9861/3] (an acute neoplasm).
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
History:
This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014.
The original answer below was written based on the rules in 2010
For cases diagnosed 2010-2011, access the Hematopoietic Database at http://seer.cancer.gov/tools/heme/. Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.
Two primaries should be accessioned: refractory anemia with excess blasts (RAEB) [9983/3], and acute myeloid leukemia [9861/3]. The steps you use to determine this MP status are:
Enter in the Heme DB to find the histology. Click on the SEARCH button. The term "refractory anemia with excess blasts" [9983/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Scroll down to the TRANSFORMATIONS section information. Refractory anemia with excess blasts (RAEB) (a chronic disease process) transforms to acute myeloid leukemia (an acute disease process). When a cell type is listed in the transformation section for a given malignancy, the disease process in the transformation section is considered the acute process and the disease listed at the top of the screen display is considered the chronic process.
Scroll to the ABSTRACTOR NOTE section for additional clarifying information regarding this diagnosis. The notes state "The chance of transforming into AML is 25% for patients with type 1 RAEB and 33% for patients with type 2." In this case there is a chronic neoplasm (RAEB) and an acute neoplasm (AML) occurring more than 21 days apart.
Determine the number of primaries. Click on the 2010 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate one of the three formats (i.e., flowchart, matrix or text) to check the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1-M13. You stop at the first rule that applies to the case you are processing.
. Abstract as multiple primaries when a neoplasm is originally diagnosed in a chronic (less aggressive) phase AND second diagnosis of a blast or acute phase more than 21 days after the chronic diagnosis. **
Determine the histology code for the acute myeloid leukemia. Enter in the Heme DB to find the histology. Click on the SEARCH button. Scroll down and highlight the term "acute myeloid leukemia, NOS" in the RESULTS FOR ALL TERMS section of the screen to identify the histology code 9861/3.
Reasons the following rules do not apply for this case:
