cv passport - european hematology association

EUROPEAN HEMATOLOGY CURRICULUM


Version 2.0 - 2012

Passport holder

European Hematology Curriculum

Name

Date of birth

Institute

Country

2

Content

Foreword .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3I The European Hematolgy Association Curriculum Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4II The updated CV Passport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7III Availability of the CV Passport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9IV Use of the CV Passport . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10V Definitions of the level descriptors .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

1 CLINICAL HEMATOLOGY: BENIGN .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 CLINICAL HEMATOLOGY: MYELOID MALIGNANCIES .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233 CLINICAL HEMATOLOGY: LYMPHOID MALIGNANCIES AND PLASMA CELL DISORDERS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274 CLINICAL HEMATOLOGY: STEM CELL TRANSPLANTATION AND SPECIAL THERAPY .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345 LABORATORY DIAGNOSIS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416 THROMBOSIS AND HEMOSTASIS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517 TRANSFUSION MEDICINE .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 578 GENERAL SKILLS .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 APPENDICES .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76

EUROPEAN HEMATOLOGY CURRICULUM 3

Keeping apace with the speed of change in hematology, whilst striving to provide a harmonized education for trainees, who can in turn deliver the best possible care for patients, is no small task. After 14 European hematologists and 2 educationalists had been incarcerated for 48 hours in Stresa, Italy in 2010, they emerged with the fleshed bones of a new European Hematology Curriculum, fully supported by the muscle of the national societies who have contributed to its development since 2004. National societies of

hematology in Europe have now had the opportunity to comment on and approve the curriculum, as laid out here in the aptly labeled “CV Passport’’, before lending their signatures of endorsement to this highly important educational tool, thus acknowledging its validity across Europe and enabling trainee hematologists to broaden their horizons. The 27 endorsements are just reward for the herculean labours of all those involved in the production of this document and testament to its potential for success.

Foreword by Professor Ulrich Jäger, President EHA

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ThisdocumentdescribestheEuropeanCurriculumfortraininginhematology,whichisaneducationaltooloftheEuropeanHematologyAssociation(EHA)andreflectstheorganization’smissionstatement:

Mission statement of the European Hematology Association (EHA)“The European Hematology Association (EHA) aims to promote excellence in clinical practice, research and education in European hematology.”

Definition of a hematologistForEHAahematologistisaphysicianwhospecializesinthediagnosis,treatment,prevention,and/orinvestigationofdisordersofthehematopoietic,hemostatic,andlymphaticsystems,anddisordersoftheinteractionbetweenbloodand

bloodvesselwall.Hematologycontainsbothclinicalandlaboratorycompetences.

The EHA Curriculum CommitteeTheEHACurriculumCommittee(seeAppendixI)wasfoundedtodevelopaharmonizedEuropeancurriculuminhematology.TheCommittee’sactivityisdevelopedincloserelationwiththeEHABoard,EHAMembersandnationalhematologysocietiesthroughoutEurope.TheCommitteeisappointedbytheboardofEHAandconsistsofphysiciansinvolvedinvariousaspectsofclinicalanddiagnostichematology.WorkinginclosecollaborationwiththeCommitteeisthenetworkofnationalrepresentatives,theso-calledlinkers,whoareappointedbytheirrespectivenationalsocieties.

I The European Hematology Association Curriculum Project

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The role of European Commission FundingThestartoftheHematologyCurriculumwastheECLeonardodaVinci(LdV)fundedproject“TheEuropeanCouncilforAccreditationinHematology”orECAH2004-2006,withEHAastheleadingorganization.Thisprojectresultedinthreemainachievements-theEHACurriculum,theEHACMEsystem,andtherestorationofhematologyasanEU-recognizedspecialty.ECAHalsoledtotheestablishmentofthenetworkofnationallinkers.TheCurriculumCommitteeandthenetworkremainedactiveaftertheendoftheECAHprojectandjointlydevelopedthebasisforthesubsequentLdV-fundedproject,H-Net2008-2011.

H-NetThemajoraimofH-Netistoharmonizeandimprovetraininginhematologybycreatingaplatformfor

targetededucation,basedonidentifiedcompetencegapsinindividuals,countriesandregionsandanewsystemoftrainingandcommunication.TheEHAEuropeanCurriculumplaysanimportantroleinthisproject.

The European Curriculum for training in Hematology, the “CV Passport” TheCurriculumCommitteeemploystheterm“Passport”todemonstratethatitsprogramisintendedtopromoteharmonizationofthespecialty,aswellasprofessionalmobilitywithintheEuropeancommunity.Italsoaimstoimprovethequalityofpatientcare.Itdescribestheskillsandcompetencesofajuniorspecialistinhematologyandshouldbeconsideredasasetofrecommendations.ThefirstversionoftheEuropeanCurriculumforHematologywascreatedthrougha“bottom-up’’


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processandfirstpublishedinMay2006.TheCVPassportconsistsofsectionsofhematologicalcompetencesand,withineachsection,alistofitems.Foreachitem,arecommendedlevelofcompetenceisagreedupon.AllthenationalsocietieslistedinAppendixIIofthisdocumentreviewedthe2006versionofthehematologycurriculum,aslaidoutintheCVPassport,andcontributedtoitscontent.The2011versionoftheCVPassportwasupdatedbyabroadgroupofhematologists(seeAppendixIII)appointedbytheCurriculumCommitteeandtheEHABoard.Toensurecontinuity,anumberofthesewereselectedfromtheinitialgroup.Theupdatedversionwasthenreviewedbythenationalsocietiesmentionedabove.BoththepreviousandthepresentversionofthecurriculumwereendorsedbynationalsocietiesforhematologythroughoutEurope.

Further updatesThecurriculumwillbereviewedperiodicallybytheEHABoardandCurriculumCommittee,incollaborationwiththenationalhematologyassociationsthroughoutEurope.

7EUROPEAN HEMATOLOGY CURRICULUM

The scope of the CV PassportTheCVPassportfocusesonhematologyasamono-specialtyincludingclinicalanddiagnosticaspects.Italsodefinesthedegreeofcompetenceininternalmedicinethatisrequiredtobeahematologist,butdoesnotfocusonthedetailsofthisspecialty.Likewise,itdoesnotdiscussthenon-hematologicalpartsofeducationinpediatrichematology.Moreover,itshouldbeusedwithreferencetodifferencesindiseaseincidencesandpatientcarewithinEurope.Insuchinstances,nationaladaptationsmaybeappro-priate.Finally,theCVPassportincludesgeneralskillswithrelevancetohematologicalpractice.ItshouldbeunderlinedthattheCVPassportdefinesthelevelsofcompetenceforbasiceducationinhematology(juniorspecialist).Continuousprofessionaldevelopment,maintenanceofcompetence,aswellassub-specialization,arenotaddressedintheCVPassport.

Recommended length of trainingGiventhescopeofthedisciplineofhematology,asdescribedintheHematologyCurriculum,andconsideringtheresultsofthe2010Europeansurvey,conductedaspartoftheH-Netproject,H-NetbelievesitcansupporttheEuropeanUnionbyrecommendingthattheminimumtrainingrequirementforHematologybefiveyears,orthreeyearswhenprevioustrainingencompassedtheequivalentofatleasttwoyearsininternalmedicine.The2010surveyshowsthatthemedianlengthoftrainingis62monthsinspecialisttrainingand30monthsinhematologytraining.However,thereisamarkedvariationbetweencountries–46-90monthsintheformerand13-51monthsinthelatter.

II The updated CV Passport

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Major changes in the 2012 version• TheclinicalpartoftheCVPassporthasexpanded

fromonetofoursections–benignhematology,myeloidmalignancies,lymphoidmalignancies,andstemcelltransplantationandspecialtherapy.Togetherwithdiagnosis,thrombosisandhemostasis,transfusionmedicine,andgeneralskills,theCVPassportnowconsistsofeightsections.

• Newitemsofhematologicalknowledge,incorporatedintoroutinecaresincethe2006version,havebeenadded.Otheritemshavebeenremovedorsimplified.


AnindividualundergoingtraininginhematologymaydownloadawebversionoftheCVPassportfromtheEHAwebsiteatwww.ehaweb.org.AprintedversionisalsoavailabletoorderfromEHA.

III Availability of the CV Passport

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How to carry out an assessment using the CV PassportEachitemintheCVPassportcanbeassessedatthreelevelsofcompetence.Todecidewhichleveltochoose,thefollowingguidanceshouldbereadcarefully.TheCVPassportcontainsdifferenttypesofitems.Someitems(especiallyinSections1-4oftheCVPassport)refertoclinicalconditionsandthecompetencelevelsrefertotheabilitytomanagetheseconditions.Someitemsrefertoknowledgeneededbythehematologist(forexampleofguidelines);sometotheskillsneeded(forexamplecommunication);andsomerefertotheskillsinvolvedinperformingandinterpretingdiagnosticprocedures.Theindividualmakinganassessmentshouldrefertotheleveldescriptorwhichismostappropriatetotheitembeingassessed.

IV Use of the CV Passport


Level 1 descriptors: The trainee can:

Patient management • identify the correct categorisation of the condition and recognise a patient

who may fall into this categorisation [note: may not have seen a patient with

condition]

Laboratory skills and

diagnosis

• describe the general range of tests available and relevant to specific

hematological conditions

Transfusion medicine • identify the clinical indications for a transfusion, of whichever blood

component

Knowledge of

professional issues

• describe what is meant by a specific issue and explain why this issue is

important for the hematologist

General professional

skills

• describe what is meant by a specific item and explain why these skills are

important for the hematologist

V Definitions of the level descriptors

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Level 2 descriptors: Thetraineecan:

Patient management • describeinbasictermsthepathogenesis,epidemiology,andclinicalfeatures

associatedwiththecondition

• identifysymptomsandtestsrequiredtodiagnoseconditionandinterprettest

resultscorrectly

• describeprognosis

• inrelationtocommonconditionswithestablishedtreatmentprotocols,

identifycorrectreferralroutesOrinitiateappropriatetreatment[NOTE: will

normally have seen patients with condition instead of their test results]

• inrelationtorareconditions,particularlythosewithpotentiallylife-

threateningdebutsymptoms,identifytheneedforandestablishurgent

consultationwithsubspecialist

Laboratory skills and

diagnosis

• inrelationtospecificlabtests,explain:indications;principles;sensitivityand

specificity;limitations;costs


Transfusion medicine • manageatransfusionreaction

• determineexpectedpost-transfusionmodificationsofbloodparameters

• performbloodcollection

• interpretimmunohematologyreport

Knowledge of

professional issues

• defineandexplainkeytermsinrelationtotheissueanddemonstratehow

theyareappliedinownpractice

General professional

skills

• demonstrateflexibleskillsunderarangeofconditionsinownpractice

(e.g.,patientswithreducedautonomy,patientsfromdifferentbackgrounds,

seriouslyillpatients,etc)

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Level 3 descriptors: Thetraineecan:

Patientmanagement • describeinmoredetailthepathogenesis,epidemiologyandclinicalfeatures

associatedwiththecondition

• identifysymptomsandtestsrequiredtodiagnoseconditionandinterprettest

resultscorrectly(asLevel2)

• decideonmanagement/treatmentandmanagethepatientduringtreatment

[NOTE: for most disorders this includes managing first-line treatment including

clinical trials, and identifying treatment failure and need for second-line

management][NOTE: will have seen and managed an appropriate number of

patients, taking into account the incidence of the condition]

Laboratoryskillsand

diagnosis

• inrelationtospecificlaboratorytests,interpretrawresultsandreport/apply

them

• inrelationtospecifictests,andrecognisingvariationinprofessionalrolesacross

Europe,performtests


Transfusionmedicine • managespecialrequirements(e.g.,plateletrefractoriness,allo-immunisation)

• selectandadministerspecialcomponents(e.g.,cryo-preservedstemcells,

autologoustransfusion)

• provideconsultationontransfusionneedsininvasiveprocedures;massive

transfusion(e.g.inpregnancy,surgery,trauma)

Knowledgeof

professionalissues

• fulfilalltherequirementsofLevels1and2,andinadditionseekoutand

integratenewknowledgeandthinkingonthespecificissue

• explainissueinappropriatelanguagetonon-specialistaudience(e.g.patient)

Generalprofessional

skills

• fulfilalltherequirementsofLevels1and2,andinadditionrecogniseandplan

howtoimproveownlimitationsinskillareasanddemonstratethatthishas

happened

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1 CLINICAL HEMATOLOGY: BENIGN

1A RED CELL DISORDERS

The trainee has received training in:

a) Anemiasduetodeficiency(iron,B12,folate)

b) Anemiaofchronicdisease

c) Anemiaduetotoxicexposure

d) Pureredcellaplasia

e) Thalassemia

f) Sicklecelldiseaseandotherhemoglobinopathies

g) redbloodcellmembranedisorders(e.g.Spherocytosis)

level1 level2 level3


h) redbloodcellenzymopathy(e.g.G6PD)

i) Acquiredimmunehemolyticanemias

j) Acquirednon-immunehemolyticanemias

k) Othercongenitalanemias(CDA,sideroblasticanemia)

l) Erythrocytosis(otherthanPV)

m)Primaryhemochromatosis

n) Secondaryhemochromatosis

o) Porphyria


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1B BONE MARROW FAILURE


a) Acquiredaplasticanemia

b) Paroxysmalnocturnalhemoglobinuria

c) Fanconi’sanemia

d) Otherinheritedbonemarrowfailuresyndromes(e.g.Blackfan-Diamond,

Schwachman)



1C NON MALIGNANT WHITE BLOOD CELL DISORDERS


a) Granulocytedysfunctiondisorders

b) Granulocytopenia/agranulocytosis

c) Lymphopeniaandlymphocytedysfunctionsyndromes

d) Inheritedimmunedeficiencysyndromes

e) Hemophagocyticlymphohistiocytosis

f) Secondaryleukocytosis


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1D PLATELET DISORDERS AND ANGIOPATHIES


a) Acquiredplateletfunctiondisorders

b) Immunethrombocytopenia

c) Thromboticthrombocytopenicpurpura

d) Pseudothrombocytopenia

e) Disorderswithteleangiectasias(e.g. Rendu-Osler-Weber disease)

(ForotherplateletdisordersseesectionCoagulation)



1E CONSULTATIVE HEMATOLOGY


a) Geneticcounseling

b) Hematologicalmanifestationsofcongenitalmetabolismdisorders

c) Hematologicalmanifestationsofnonhematologicaldisorders

d) Hematologicalmanifestationsrelatedtopregnancy

e) HematologicalmanifestationsinHIVandotherinfectiousdiseases


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SIGNATURES to be given after the completion of section 1

Date:......................................................................................... Date:...................................................................................... Date:..................................................................................

Mentor’ssignature Trainee’ssignature HeadofDepartment’ssignature

........................................................................................................... ....................................................................................................... ....................................................................................................

Instituteanddepartment

..............................................................................................................................................................................................................................................................................................................................


2 CLINICAL HEMATOLOGY: MYELOID MALIGNANCIES

2A MYELOPROLIFERATIVE AND MYELODYSPLASTIC NEOPLASMS


a) Chronicmyeloidleukemia

b) Polycythemiavera

c) Primarymyelofibrosis

d) Essentialthrombocythemia

e) Chroniceosinophilicleukemia

f) Mastocytosis


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g) NeoplasmswitheosinophiliaandabnormalitiesofPDGFrand/orFGFr1

h) CMML

i) MDSlowriskdisease

j) MDSintermediateandhighriskdisease

k) OtherMyeloproliferativeandMyelodysplasticdisordersincludingpediatric

disorders(e.g.,JMML)



2B ACUTE MYELOID LEUKEMIA AND LEUKEMIAS OF AMBIGUOUS LINEAGE


a) AMLwithrecurrentgeneticabnormalities

b) AMLwithMDSrelatedchanges

c) TherapyrelatedAMLandMDS

d) OtherAML

e) MyeloidproliferationsrelatedtoDownsyndrome

f) Acuteleukemiaofambiguouslineage


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Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


..............................................................................................................................................................................................................................................................................................................................


3 CLINICAL HEMATOLOGY: LYMPHOID MALIGNANCIES AND PLASMA CELL DISORDERS

3A B-CELL NEOPLASMS


a) Acutelymphoblasticleukemia/lymphoblasticlymphoma

ofB-cellorigin

b) DiffuselargeB-celllymphoma

c) Burkitt´slymphoma

d) OtheraggressiveB-celllymphomas(e.g.unclassifiable,primarymediastinal

largeB-celllymphoma,intravascular,plasmablastic,ALK+large B-celllymphoma)


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e) Mantlecelllymphoma

f) Follicularlymphoma

g) OtherindolentB-celllymphomas(e.g.lymphoplasmacytic

lymphoma/Waldenström´smacroglobulinemia,hairycellleukemia)

h) MarginalZonelymphomas(e.g.MALT,SMZL)

i) Chroniclymphocyticleukemia/smalllymphocyticlymphoma/monoclonal

B-celllymphocytosis



3B T-CELL LYMPHOMAS AND NK-CELL NEOPLASMS


a) Acutelymphoblasticleukemia/lymphoblasticlymphomaofT-cellorigin

b) PeripheralT-celllymphoma,NOS

c) Anaplasticlargecelllymphoma

d) OtherT-andNK-celllymphomas(incl.AILT,T-PLL,T-LGL,NK-cell

lymphoma/leukemia)


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3C HODGKIN LYMPHOMA


a) NodularlymphocytepredominantHL

b) ClassicalHL



3D OTHER SPECIAL ENTITIES


a) Lymphomasinimmunodeficientpatients(incl.PTLD,HIV-associated

lymphomas)

b) Cutaneouslymphomas

c) PrimaryCNSlymphoma

d) Histiocyticanddendriticcellneoplasms


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3E PLASMA CELL NEOPLASMS


a) Monoclonalgammopathyofundeterminedsignificance(MGUS)

b) Solitaryplasmacytoma

c) Plasmacellmyeloma(Multiplemyeloma)

d) Monoclonalimmunoglobulindepositiondiseases(amyloidosis)




Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


..............................................................................................................................................................................................................................................................................................................................

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4 CLINICAL HEMATOLOGY: STEM CELL TRANSPLANTATION AND SPECIAL THERAPY

Training within the field of stem cell transplantation should ideally be done at a JACIE accredited unit


4A STEM CELL TRANSPLANTATION


a) Indications,risksandbenefitsofautologousandallogeneictransplants

b) Criteriaforselectionofmyeloablativeorreduceddosepreparativeregimens

c) Administrationofhigh-dosetherapy

d) IdentificationandselectionofHPCsource

e) Acuteandchronicgraftversushostdisease

f) Pulmonarycomplications,veno-occlusivediseaseoftheliver,and

hemorrhagiccystitis

g) Evaluationofchimerism

h) Mobilization,collectionandmanipulationofhemopoeiticstemcells


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4B CELL AND GENE THERAPY


a) Clinicalpotentialandlimitsofembryonicandadultstemcelltherapy.

Ethicalconsiderations

b) Clinicalpotentialandlimitsofgenetherapy

c) MesenchymalcellsandNK-celltherapy

d) Tumorvaccines



4C TREATMENT OF HEMATOLOGICAL DISORDERS


a) Drugtherapyincludingtargeteddrugs:mechanismsofaction,pharmacology

anddrugresistance

b) Administrationofstandardchemotherapy

c) Shortandlongtermcomplicationsofchemotherapyandradiotherapy

(includinginfertilityandsecondaryneoplasias)

d) Administrationofimmunosuppressiveagentsandgrowthfactors

e) Hematologicalmalignanciesinpregnancy


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4D INFECTIOUS COMPLICATIONS


a) Neutropenicfever

b) Bacterialdisease

c) Fungaldisease

d) Cytomegalovirus(CMV)infection

e) Otherviralinfectionsinimmunocompromisedhosts



4E SUPPORTIVE AND EMERGENCY CARE


a) Hyperleukocytosis,hyperviscosity,andtumorlysissyndrome

b) Spinalcordcompression

c) Superiorvenacavasyndrome

d) Mucositis,vomiting,andpain

e) Neurologicalandpsychiatricdisturbances

f) Venousaccessmanagement(exceptsurgicalaspects)

g) Nutrition


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Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


..............................................................................................................................................................................................................................................................................................................................


5 LABORATORY DIAGNOSIS

5A BASIC CONCEPTS


a) Hematopoiesis

b) Stem cell biology

c) Chromosome and gene structure

d) The role of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) and

proteins in normal cellular processes

e) Basic concepts of transcription and translation, epigenetic regulation,

signal transduction, cell cycle regulation and apoptosis

f) Integrating data from various laboratory investigations, relating them to the

clinical picture and formulating a diagnosis

level 1 level 2 level 3

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5B GOOD LABORATORY PRACTICE


a) Principlesoflaboratorymanagementandorganization

b) Laboratoryqualitymanagement(incl.internalandexternalqualitycontrol)

c) Hazardsandsafety

d) Normalrangesoflaboratoryvalues,withrelevancetogender,ageandethnicity



5C BLOOD COUNT AND MORPHOLOGY

The trainee should be familiar with the procedures, reporting and clinical evaluation of blood cell counts and morphology in order to formulate and communicate a plan of action.


a) Automatedcompletebloodcountwithwhitebloodcelldifferential;

“flagging”;causesoferroneousbloodcounts

b) Performingaspirationandbiopsyofbonemarrow,lumbarpuncture

andlymphnodefineneedleaspirationandpreparationofslides,touch preparationsandtrephinerolls

c) Preparation,fixation,staining,readingandreportingofperipheralblood

smearsandbonemarrowaspirates

d) ExaminationofbloodandbonemarrowsmearsforrBCparasites


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e) Cytochemicalandspecialstainsofbloodandbonemarrowsmears

f) Histopathologyinregardtohematologicalconditions.

reviewoftrephinebiopsy,pathologicallymphnodeandothertissue biopsiesfordiagnosiswithapathologist

g) Immunostaininginhematologicalmalignancies(lymphoid-lineage,

myeloid-lineageanddifferentiationmarkers)



5D OTHER LABORATORY TECHNIQUES


a) Hemoglobinanalyses(e.g.,hemoglobinelectrophoresis)

b) Otherredbloodcelllaboratorytechniques(e.g.,sicklingprocess,

oxygenaffinity,redbloodcellenzymeassays–pyruvatekinase, glucose-6-phosphatedehydrogenase)

c) Laboratorywork-uponironmetabolismandvitamindeficiencies

d) Detectionofimmunoglobulinabnormalities(e.g.,proteinelectrophoresis,

immunoelectrophoresis/immunofixation,cryoglobulindetection, lightchainassays)


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5E IMMUNOPHENOTYPING BY FLOW CYTOMETRY

The trainee should be familiar with the interrelated stages of multi-parameter flow cytometry (FCM) analysis from the initial medical decision to the final diagnosis including integration with relevant clinical and laboratory information.


a) Pre-analyticalandanalyticalphaseofflowcytometryofblood,bonemarrow,

andbodyfluids(e.g.,specimenprocessing,surfacevs.intracytoplasmicstaining, acquiringdata,gatingstrategies)

b) Essentialcellularmarkersappliedinthediagnosisofhematologicalconditions

(e.g.,lineage,progenitoranddifferentiationmarkers)

c) Generalprinciplesofdisease-orientedantibodypanels

d) Post-analyticalphase(dataanalysisanddeterminationofthelineageof

cellsofinterest,clonalityandspecificsubtypeofhematologicalcondition)



e) Applications,limitationsandprognosticimpactfordiagnosisand

classification,evaluationofminimalresidualdisease,stemcell quantification


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5F GENETICS AND MOLECULAR BIOLOGY

The trainee should be familiar with the interrelated stages of genetic and molecular studies from the initial medical decision of the most appropriate methodological approach in a particular hematological condition, to the final diagnostic and prognostic interpretation, including integration with relevant clinical and laboratory information.

The trainee has to use the definitions of chromosomal abnormalities according to the International Nomenclature of aberrations (e.g., reciprocal translocation, deletion, inversion, monosomy, trisomy, etc.) and/or their molecular counterparts.


a) Karyotyping(e.g.,conventionalcytogeneticsandfluorescenceinsitu

hybridization)

b) Polymerasechainreactionforthedetectionofgenemutations,

fusiongenes,clonalityassessment,andgeneexpression(e.g.,reverse transcription-polymerasechainreaction,qualitativeandquantitative,sequencing)



c) Othertechniquesfordetectionofgeneticandepigeneticaberrations

(e.g.,Westernblot,CGH,SNP,geneexpressionprofiling, high-throughputsequencing,microrNAassays,methylationstudies andproteomics)

d) Applications,limitationsandprognosticimpactofgeneticandmolecular

aberrationsfordiagnosisandclassificationofhematologicaldisorders, andforevaluatingminimalresidualdisease


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Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


..............................................................................................................................................................................................................................................................................................................................


6 THROMBOSIS AND HEMOSTASIS

The practice of clinical hemostasis and thrombosis requires a combination of diagnostic laboratory and clinical expertise. As in other areas of clinical hematology there is a major overlap with general internal medicine. Therefore a holistic approach to disease management requires adequate training in general internal medicine as well as in hemostasis and thrombosis.

6A LABORATORY MANAGEMENT


a) Techniquesforassessingcoagulationandplatelets

b) Assaysforinhibitors(e.g.,anti-phospholipidantibodies)

c) Establishingranges,includingrelevancetogenderandage


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6B ACQUIRED BLEEDING DISORDERS


a) Massivebleedinginobstetrics,traumaandsurgery

b) Disseminatedintravascularcoagulation(DIC)

c) Bleedingassociatedwithrenalandliverdisease

d) Bleedingrelatedtoanticoagulantsandantithrombotictherapy

e) Acquiredbleedingdisordersinadults(inhibitorstoFVIIIandvWF)

f) Acquiredbleedingdisordersinchildren

g) Adverseeffectsoftreatmentusedinacutebleeding(bloodproducts,

pro-hemostaticdrugs)



6C CONGENITAL BLEEDING DISORDERS


a) Mechanismsinhemostasis

b) Takingarelevantbleedinghistory(previouschallengesandfamilyhistory)

withafocusedclinicalexamination

c) HemophiliaA&B

d) VonWillebranddisease

e) Otherbleedingdisorders(e.g.,deficiencyoffactorXIII,XI,X,VII,VandII,

andhypofibrinogenaemia)

f) Considerationsincarriersofhemophiliainrelationtopregnancyand

managementofneonateswithhemophilia

g) Safetyoftreatmentwithbloodproductsandfactorconcentrates


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6D PLATELET DISORDERS


a) Plateletstructure,functionandvesselwallinteractions

b) Congenitalplateletdisorders,(e.g.,Bernard-Souliersyndrome)

c) Heparin-inducedthrombocytopenia

d) Thrombocytopeniainpregnancy



6E THROMBOTIC DISORDERS


a) Mechanismsandrisk-factorsinarterialandvenousthromboembolism

b) Venousthromboembolism

c) Laboratorymonitoringanddosingofanticoagulants

d) Post-thromboticcomplications

e) Thrombophilia(e.g.,FVLeiden,IIG20210A)

f) Acquiredthrombotictendency,(e.g.,APS,HIT,PNHandMPN)

g) Treatmentandprophylaxisofvenousthromboembolisminpregnancy

h) Specifictherapyinthromboticdisorders(e.g.,cavalfilters)


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i) Purpurafulminans

j) Adversedrugreactionstoanticoagulant,antiplateletandthrombolytictherapy


Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


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7 TRANSFUSION MEDICINE

7A BLOOD DONATION


a) CouncilofEuropeandotherrelevantregulationsfordonoreligibility

b) Epidemiologyofinfectiousdiseasesinthearea

c) Donorpreparation;venesection,donationscreening,donationassociated

adverseevents

d) Preparationandpreservationofstandardandspecialbloodcomponents

(wholeblood;redcells;plasma;platelets.Cryoprecipitate;irradiated; leukocytedepleted;washed;pathogenreduced;PediatricUnits)


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7B IMMUNOHEMATOLOGY


a) Crossmatching,directandindirectantiglobulin(Coombs)tests,

ABOandrhtypingofredbloodcells

b) HLAtypingandanti-HLAantibodydetection

c) Minorredcellantigensandantibodies



7C GUIDELINES AND REGULATIONS FOR USE OF BLOOD AND BLOOD COMPONENTS


a) redcells,platelets,plasma

b) Granulocytes

c) Bloodderivatives(incl.immunoglobulins)

d) Alternativestoallogeneicbloodtransfusion(autologousblood;useof

r-huEPO,ironetc)

e) Massivetransfusion(insurgery,trauma,pregnancy,etc)


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7D ADMINISTRATION OF TRANSFUSION AND MANAGEMENT OF COMPLICATIONS


a) Informationtothepatient

b) routinevs.emergencytransfusions

c) Properidentificationoftheunitandrecipient

d) rateandconditionsofadministrationandmonitoring

e) Fetal,neonatalandpediatrictransfusion

f) Transfusionreactionsandcomplications(non-hemolytic,hemolytic,allergic,

transfusion-relatedacutelunginjuryTrALI,transfusionassociatedGvHD)

g) Hemovigilanceprograms



7E MANAGEMENT OF SPECIAL CONDITIONS


a) Hemolyticdiseaseofthenewborn

b) Neonatalthrombocytopeniaandneutropenia

c) Laboratorywork-upofimmunehemolyticanemias

d) Plasmapheresis

e) redcellexchange

f) Plateletpheresis

g) Leukapheresis(therapeutic)

h) Donationbyapheresis


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i) Multi-componentcollection

j) Performingtherapeuticphlebotomy

k) Specialcomponents(Leukoreduced,CMVsafe,washed,gammairradiated,

pathogenreduced,cryopreserved)




Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


........................................................................................................... ....................................................................................................... ....................................................................................................


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8 GENERAL SKILLS

For any specialty, the acquisition of general skills is an important part of training. The core concepts and practical skills listed here are essential for a specialist in hematology and should be a part of the training either in medical school or as part of specialty training. Naturally, there are other general skills which are not listed here.

8A EVIDENCE BASED MEDICINE / CRITICAL APPRAISAL

The trainee should have daily access to the internet. It is recommended that, during training, a doctor actively participates in a journal club, either locally or via the internet. The parts recommended below also include understanding of appropriate statistics.


a) Fundamentalprinciplesofevidencebasedmedicine

b) Using scientificliteratureandcriticallyevaluatinginformation



c) Biostatisticsthatwillallowthetraineetointerpretpublishedliterature

d) Definitionanddisclosureofconflictofinterestaswellascurrent

conflict-of-interestpolicies,(e.g.,standardsofconductincollaboration betweenphysiciansandindustry)

e) Promotionbytheindustryanditseffectontherationaluseofdiagnosticand

therapeuticstrategies

f) Applyingevidencebasedpracticetothemanagementoftheindividualpatient

g) Strategicandeconomicimplicationsofcombiningdrugsandclinicalbiomarkers

(personalizedmedicine)

h) Problembasedlearningtechniques


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8B GOOD CLINICAL PRACTICE / CLINICAL TRIALS

The trainee should have the opportunity to actively participate in the clinical trial process and take part in at least one course in good clinical practice and national legislation. The aspects described below also include an understanding of appropriate statistical analysis.


a) Identifyingthedifferentphases,typesandpurposesofclinicaltrials

(e.g.,phase1-4,observationalstudies)aswellasunderstandingthe differencesbetweenindustry-drivenandinvestigator-drivenclinicaltrials

b) Applyingthecurrentversionsofclinicaltrialrelatedguidelinesandlegislation

(Directive2001/20/EContheimplementationofGoodClinicalPracticein ClinicalTrials,WorldMedicalAssociationDeclarationofHelsinki(2008)onEthical PrinciplesforMedicalresearchInvolvingHumanSubjects)

c) ApplyingtheAppendix2totheGuidelineontheevaluationofAnticancerMedicinal

ProductsinManonconfirmatorystudiesinhematologicalmalignancies



d) Informingpatientswithvarioussocial,cultural,religiousetc.backgroundsof

allaspectsrelatedtoclinicaltrials

e) Obtainingtheinformedconsentaccordingtocurrentregulations

f) Treatingandmanagingpatientsaccordingtoprotocolrequirementsandknowing

whentodivergefromtheprotocol


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8C PHARMACOVIGILANCE

The trainee should understand the activities involved in the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems.


a) Usingtermsrelevanttodrug-relatedharms(e.g.,seriousadverseevent,

adversedrugreaction,risk-benefitratio,toxicityandmedicationerror)

b) recognizing,documentingandtreatingadversedrugevents

c) NationalandEUlegislationregardingpharmacovigilancesystems

d) Proceduresandsystematicpost-marketingsurveillancestudiesaimedat

assessingthefullsafetyprofileofdrugs(e.g.,riskmanagementplan, riskevaluationmitigationstrategy,post-authorizationsafetystudies)



8D ETHICS AND LAW


a) Principlesofmedicalethicscentraltothephysician-patientrelationship

(e.g.,principleofprimacyofpatients’welfare,patients’autonomy, socialjustice)

b) ThepurposeandfunctionoftheresearchEthicsCommittee(rEC)and

otherregulatorybodiesthatoverseetheconductofclinicalinvestigations

c) Professionalresponsibilities(e.g.,respectforpatient’sautonomy,

non-maleficence,beneficence,justice)

d) Multidisciplinarydiscussionaboutethicaldilemmasinclinicalpractice

(e.g.,managingpatientswithreducedautonomy)

e) TherelationshipbetweenhealthcareprovidersandnationalandEuropean

authorities,tissuebanks,insurancecompanies,includinglegislation


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f) Cost-effectivenessreasoningandjustallocationofscarceresources

(e.g.,rationalization,rationing,prioritization)

g) Assessingqualityoflifemeasures

h) Currentmoralunderstandingofnon-discriminationprinciplesand

humanrights



8E COMMUNICATION SKILLS

The trainee should have the opportunity to take part in at least one course on communication skills


a) Communicationwithpatientswithhematologicaldisorders

(includingcommunicatingsad,badanddifficultinformationandmanaging patientswithdifferentculturalbackgrounds)

b) Communicationwithpatients’relatives

c) Communicationwithinamulti-disciplinaryteam

d) Presentationofclinicalcases


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8F PSYCHOSOCIAL ISSUES


a) respondingtonormalpsychologicalreactionstohematologicaldiseases

b) recognizingpsychologicaldistress,socio-economicproblems,andidentifying

theneedforspecialistresources

c) Patients’rightsaccordingtonationallegislation



8G HEMATOLOGICAL CARE IN THE ELDERLY PATIENT


a) Theeffectsofspecificchangesassociatedwithagingandtheirimpactonnormal

hematologicprocesses

b) Theimpactofageonthepharmacodynamics,pharmacokineticsandrisksof

drugsusedtotreathematologicdisorders

c) Patients’carebasedonageriatricassessment


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8H END-OF-LIFE


a) Communicationwithpatientsandfamilyaboutdeathanddying

b) Decisionmakingrelatedtoend-of-lifesituations

c) recognizingphysical,psychological,socialorspiritualdistressand

identifyingtheneedforspecialistpalliativecare

d) Potentialindicatorsofthequalityofend-of-lifecare

e) Collaborationofthemulti-professionalteamwithpatientsandfamily

f) Bestpracticeinthelasthoursanddaysoflife,includinguseofeffective

symptomatictreatmentforpatientsapproachingdeath

g) Thenationallegalrequirementsregardingeuthanasia




Date:......................................................................................... Date:...................................................................................... Date:..................................................................................


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APPENDICES

APPENDIx I

EHA Curriculum Committee:

Eva Hellström-Lindberg KarolinskaUniversityHospitalHuddinge,SwedenNancyHamilton EuropeanSchoolofHaematologyAmbjörnNaeve UppsalaUniversityLearningLab(ULL),SwedenPaolorebulla FoundationOspedaleMaggiorePoliclinico,MangiagalliereginaElena,

ItalyJanetStrivens UniversityofLiverpool/TheCentreforLifelongLearning,UKCheng-HockToh royalLiverpoolUniversityHospital,UKLaurentDegos HauteAutoritédeSanté,FranceWolf-DieterLudwig HeliosKlinikumBerlin-Buch-KlinikfürHämatologie,Onkologieund

Tumorimmunologie,Germany


APPENDIx II

National Societies/Project Partners in H-Net:• AustrianSocietyofHematologyandOncology• BelgianHematologySociety• BritishSocietyofHematology• BulgarianSocietyofClinicalandTransfusion

Hematology• CzechHematologySociety(amemberoftheCzech

MedicalSociety)• DanishSocietyofHematology• DutchSocietyofHematology• EstonianSocietyofHematology• EuropeanHematologyAssociation(coordinator)• EuropeanSchoolofHaematology(ESH)• FrenchSocietyofHematology• GermanSocietyofHematologyandOncology• HaematologyAssociationofIreland• HellenicSocietyofHematology• HungarianSocietyofHematology• ItalianSocietyofHematology(SIE)

• NorwegianSocietyofHematology• PolishSocietyofHematologyandTransfusion

Medicine• PortugueseSocietyofHematology• romanianSocietyofHematology• SlovakSocietyofHematologyandTransfusiology

ofSlovakMedicalAssociation• SpanishSocietyofHematologyandHemotherapy• SwedishSocietyofHematology• TurkishSocietyofHematology• UniversityofLiverpool/TheCentreofLifelong

Learning• UppsalaUniversity/UppsalaLearningLab(ULL)

Associate partners:CroatianHematologyandBloodTransfusionSocietyIsraeliSocietyofHematologyandBloodTransfusionSwissSocietyofHematology

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APPENDIx III

Curriculum Update Working Group:

Member Section Role Country

EvaHellström-Lindberg 1,2 hematologist, Chair Curriculum Committee/Project leader H-Net Sweden

GertOssenkoppele 1,2 hematologist TheNetherlands

UlrichJäger 3 hematologist Austria

TomasNavarro 3 hematologist Spain

AlvaroUrbano 4 hematologist Spain

HamdiAkan 4 hematologist Turkey

MargaritaGuenova 5 hematologist Bulgaria

BirgittaSander 5 hematopathologist Sweden

MargaretaHolmström 6 hematologist/coagulation specialist Sweden

Cheng-HockToh 6 hematologist/coagulation specialist UK

Paolorebulla 7 transfusion medicine specialist Italy

CharisMatsouka 7 hematologist Greece

Wolf-DieterLudwig 8 hematologist Germany

DominiqueBron 8 hematologist Belgium

JanetStrivens all educational advisor UK


Member Section Role Country

AmbjörnNaeve all technical advisor Sweden

ThomDuyvenédeWit all EHA Executive Office TheNetherlands

GarethEvans-Jones all EHA Executive Office TheNetherlands

VictoriaChuvakova all EHA Executive Office TheNetherlands

NinaStraathof all EHA Executive Office TheNetherlands

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• AustrianSocietyofHematologyandOncology• BelgianHematologySociety• BulgarianSocietyofClinicalandTransfusion

Hematology• CzechHematologySociety(amemberofthe

CzechMedicalSociety)• DanishSocietyofHematology• DutchSocietyofHematology• EstonianSocietyofHematology• FinnishAssociationofHematology• FrenchSocietyofHematology• GermanSocietyofHematologyandOncology• HaematologyAssociationofIreland• HellenicSocietyofHematology• HungarianSocietyofHematology• IsraeliSocietyofHematologyandBlood

Transfusion

• ItalianSocietyofHematology(SIE)• LatvianHematologySociety• MacedonianSocietyofHematology• NorwegianSocietyofHematology• PolishSocietyofHematologyandTransfusion

Medicine• PortugueseSocietyofHematology• romanianSocietyofHematology• SlovakSocietyofHematologyandTransfusiology

ofSlovakMedicalAssociation• SlovenianSocietyofHematology• SpanishSocietyofHematologyandHemotherapy• SwedishSocietyofHematology• SwissSocietyofHematology• TurkishSocietyofHematology

APPENDIx IV

The European Hematology Curriculum has been endorsed by the:

cv passport - european hematology association

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