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SEER Inquiry System - Report
Produced: 11/25/2024 12:12 AM
Question 20190084
Inquiry Details
References:
#1: WHO Class Hem & Lymph Tumors, 30-36. 4th edition
#2: Bauer S,Romvari E. Interpreting molecular monitoring results and international standardization in chronic myeloid leukemia. J Adv Pract Oncol. 2012 May;3(3):151-60. PMID: 25031941; PMCID: PMC4093320.. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4093320/
Question:
Histology/Heme & Lymphoid Neoplasms: Should the histology be coded to chronic myeloid leukemia (CML), BCR-ABL1-positive (9875/3) regardless of the quantitative analysis percentage of BCR-ABL1 that was detected? See Discussion.
Discussion:
Example: Bone marrow biopsy diagnosis is chronic myelogenous leukemia, chronic phase, and the RT-PCR test result proved, BCR-ABL1 p210 (Major Breakpoint) - Detected, 3.3659%.
Even though the p210 fusion transcript was less than 5%, it was detected. The presence of BCR-ABL1 does define whether or not patients are treated with tyrosine kinase therapies. Therefore, it seems likely that the presence of any BCR-ABL1 would be captured using the more specific histology code 9875/3, instead of the non-specific CML, NOS histology code 9863/3.
Are there minimum threshold requirements for these quantitative studies in order to code the histology to the more specific type of CML?
Answer:
Code chronic myeloid leukemia (CML) BCR-ABL1-positive as 9875/3.
According to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th edition, CML BCR-ABL1-positive is characterized by the chromosomal translocation t(9;22) which results in the formation of the Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. The diagnosis requires detection of the Ph chromosome and/or BCR-ABL1. If the mutation is detected, regardless of percentage, it is positive. Quantitative levels of BCR-ABL are used to monitor response to tyrosine kinase inhibitor therapy.
