When it comes to deciding whether to order next-generation sequencing (NGS) for patients with actual or suspected myeloid neoplasms (MN), a Yale School of Medicine team emphasizes the importance of careful consideration. This approach could lead to significant savings for institutions without compromising patient care. Their set of criteria aims to determine the appropriateness of NGS testing for MN (MN-NGS), maximizing actionable results.
"Maximize Care, Minimize Costs with MN-NGS Criteria"
Appropriate NGS Testing for MN
In group A, where NGS testing was appropriate, the most frequently applicable approval criterion was the existence of a new diagnosis or clinical suspicion of MDS without increased blasts after a negative workup. This shows the value of targeted testing in such cases, as it can lead to accurate diagnoses and appropriate treatment plans. For example, a patient presenting with new symptoms and a suspected MN could benefit from MN-NGS to clarify the diagnosis and guide further treatment.Another aspect of appropriate NGS testing is characterizing an MN with baseline mutational status for follow-up purposes. This allows for better monitoring of the disease and the ability to detect any changes in the mutational profile over time. By having this baseline information, healthcare providers can make more informed decisions about treatment adjustments and patient care.Inappropriate NGS Testing for MN
In group B, where NGS testing was inappropriate, the most applicable cancellation criterion was that the order did not meet any approval criteria. This highlights the importance of adhering to the established criteria to avoid unnecessary testing. For instance, if there is no suspicion of progression of a known MN or no evidence of recurrence post-transplant, NGS may not be warranted. By avoiding such tests, resources can be conserved and costs can be reduced.Appropriately Canceled NGS Tests for MN
In group C, where NGS tests were appropriately canceled, the most frequent cancellation criterion was the diagnosis of a nonmyeloid disease or no suspicion for an MN. This ensures that resources are not wasted on testing for the wrong condition. For example, if a patient presents with symptoms that are clearly not related to a myeloid neoplasm, NGS can be appropriately canceled to avoid unnecessary investigations.The researchers also found that about one-third of all MN-NGS orders could be canceled without missing any actionable variant. This means that patient care is not compromised, while significant savings can be achieved. For instance, in their institution, CMS-reimbursed savings of just over $150,000 annually were calculated by canceling appropriate tests.Gene Mutations in MN Patients
For patients with a history or new diagnosis of AML at the time of ordering (n = 52), the most commonly mutated genes were RUNX1, SRSF2, and IDH2. These mutations play a crucial role in the development and progression of AML and can guide targeted therapies. Understanding these mutations is essential for providing personalized treatment.In patients with a history or new diagnosis of MDS (n = 35), the most commonly mutated genes were TP53, TET2, and SF3B1. These mutations are associated with specific subtypes of MDS and can help in predicting prognosis and guiding treatment decisions.Among tested patients with a history or newly established MPN (n = 9), the most commonly mutated genes were JAK2 and MPL. These mutations are characteristic of MPNs and can help in differentiating between different subtypes and guiding treatment.In conclusion, implementing screening criteria for MN-NGS testing can lead to more directed and cost-efficient evaluation of MNs. Larger studies are needed to confirm these findings and further optimize the use of NGS in the diagnosis and management of myeloid neoplasms.READ MORE