Appendix DGlossary

A complex procedure involving administration of high-dose cytotoxic therapy (chemotherapy with or without radiotherapy) followed by transplant of peripheral blood or bone marrow stem cells (and rarely cord blood) from a sibling or unrelated donor. This is usually followed by immunosuppression.

Without obvious signs or symptoms of disease. Cancer may cause symptoms and warning signs, but, especially in its early stages, cancer may develop and grow without producing any symptoms.

A procedure involving administration of high-dose chemotherapy followed by transplant of peripheral blood or bone marrow stem cells previously harvested from the patient

Removal of a sample of tissue from the body to assist in diagnosis or inform the choice of treatment of a disease.

Another term for allogeneic and autologous HSCT. The term ‘Bone Marrow Transplantation’ is now obsolete as most transplants use haematopoietic stem cells collected from peripheral blood as opposed to bone marrow.

The use of medication (drugs) that is toxic to cancer cells, given with the aim of killing the cells or preventing or slowing their growth.

Research studies in which groups of patients with a particular condition or specific characteristic are compared with matched groups who do not have it, or patients within the cohort are compared with each other.

Imaging technique in which the person lies on a table within a x-ray gantry. The images are acquired using a spiral (helical) path and banks of detectors, allowing presentation of the internal organs and blood vessels in different projections including 3-D views.

A type of economic evaluation that compares the costs and benefits of different treatments. In cost-effectiveness analysis benefits are measured in clinical outcome units, for example, additional heart attack prevented, life years gained, etc. When a new treatment is compared with current care, its additional costs divided by its additional benefits is called the cost effectiveness ratio.

An individual who is truly positive for a disease, but whom a diagnostic test classifies them as disease-free.

An individual who is truly disease-free, but whom a diagnostic test classifies them as having the disease

A molecular test carried out on biopsy or cytology samples to show whether extra or abnormal copies of specific genes or genetic material are present or absent.

The GRADE approach is a method of grading the quality of evidence and strength of recommendations in healthcare guidelines. It is developed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group.

A common complication following an allogeneic stem cell transplant. Immune white blood cells in the transplant (graft) recognize the recipient (the host) as “foreign.” The transplanted immune cells then attack the host's body cells.

A type of protein that stimulates the bone marrow to make white blood cells (granulocytes).

The study of the allocation of scarce resources among alternative health care treatments. Health economists are concerned with both increasing the average level of health in the population and improving the distribution of health.

Previous term used interchangeably with Bone Marrow Transplantation. Now both terms have been replaced with either Haematopoietic Stem Cell Transplantation (HSCT) and Blood and Marrow Transplantation (BMT) in order to reflect current clinical and scientific practice.

Faster growing, clinically aggressive lymphomas.

The process of detecting antigens (e.g., proteins) in the cells of a tissue section, by using antibodies binding specifically to antigens in biological tissues.

A technique used to study the protein expressed by cells. It is usually done on liquid specimens and involves the labelling of white blood cells with antibodies directed against surface proteins on their membrane. The labelled cells are processed in a flow cytometer, a laser-based instrument capable of analyzing thousands of cells per second. The whole procedure can be performed on cells from the blood, bone marrow or spinal fluid in a matter of a few hours.

Lymphomas that grow and spread slowly (also called low grade lymphomas).

The first phase of chemotherapy treatment designed to induce remission.

Small bean-shaped organs located along the lymphatic system. Nodes filter bacteria or cancer cells that might spread through the lymphatic system and to other parts of the body.

A type of scan which uses a magnetic field and radio waves to produce images of sections of the body.

Results from a collection of independent studies (investigating the same issue) are pooled, using statistical techniques to synthesise their findings into a single estimate of an effect. Where studies are not compatible e.g. because of differences in the study populations or in the outcomes measured, it may be inappropriate or even misleading to pool statistically results in this way.

Detrimental effects on health.

Either (1) the condition of being subject to death; or (2) the death rate, which reflects the number of deaths per unit of population in relation to any specific region, age group, disease, treatment or other classification, usually expressed as deaths per 100, 1,000, 10,000 or 100,000 people.

A team with members from different health care professions and specialties (e.g. urology, oncology, pathology, radiology, nursing). Cancer care in the NHS uses this system to ensure that all relevant health professionals are engaged to discuss the best possible care for that patient.

Another term for Myelodysplastic Syndrome.

A group of diseases in which the bone marrow functions abnormally and fails to produce enough normal blood cells. It may progress to acute myeloid leukaemia. Sometimes referred to as myelodysplasia.

Damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected.

An abnormally low number of neutrophils, the most important type of white blood cell to fight off bacterial infections.

Any cancer of lymphocytes other than Hodgkin lymphoma. There are two main groups – high grade which are aggressive and fast growing and low grade which are slow growing (also known as indolent lymphomas). High grade lymphomas include: diffuse large B-cell lymphoma (DLBCL), peripheral T-cell lymphoma, Burkitt lymphoma, and AIDS-related lymphoma. Low grade or indolent lymphomas include: follicular lymphomas, mantle cell lymphoma, lymphoplasmacytic lymphoma and marginal zone lymphomas. Extra-nodal lymphomas are those that develop outside lymph nodes such as those affecting the skin or intestine.

Anything which serves to alleviate symptoms due to the underlying cancer but is not expected to cure it.

The small blood cells involved in stopping bleeding

A technology in molecular biology used to amplify a single copy or a few copies of a piece of DNA, generating thousands to millions of copies of a particular DNA sequence.

A medical imaging technique using a device which combines a positron emission tomography (PET) scanner (which utilises a radioactive tracer to show functional activity) with an x-ray computed tomography (CT) scanner. Images acquired from both devices can be taken sequentially, in the same session, and combined into a single superposed image.

The proportion of a population found to have a condition

A prediction of the likely outcome or course of a disease; the chance of recovery, recurrence or death.

Specific characteristics of a cancer or the person who has it which might affect the patient's prognosis.

A study in which people are entered into research and then followed up over a period of time with future events recorded as they happen.

A general term for any non-therapeutic intervention that helps a person cope with stressors in the home or at work.

Research in which the outcomes are usually recorded in words, rather than with numbers. Often used to explore and understand peoples' beliefs, experiences, attitudes, behaviour and interactions.

A measure of health outcome, which looks at both length of life and quality of life. QALYs are calculated by estimating the years of life remaining for a patient following a particular care pathway and weighting each year with a quality of life score (on a 0-1 scale). One QALY is equal to 1 year of life in perfect health, or 2 years at 50% health, and so on.

Research which uses numerical measurement techniques (e.g. measuring survival times after treatment).

The use of radiation, usually high energy x-rays to control the growth of cancer cells.

An experimental clinical trial (study) investigating the effectiveness of different treatments in which participants are assigned at random to different groups which receive the intervention being assessed or a ‘control’ treatment. RCTs give the most reliable (i.e. least biased) form of evidence on clinical effectiveness.

Where cancer starts to grow again after treatment.

A period when cancer has responded to treatment and there are no signs of cancer or cancer-related symptoms. In haematological cancers, there are specific criteria for remission depending on the condition, depending on blood and bone marrow and/or radiological assessments.

In diagnostic testing, it refers to the chance of having a positive test result given that you have the disease. 100% sensitivity means that all those with the disease will test positive, but this is not the same the other way around. A patient could have a positive test result but not have the disease – this is called a ‘false positive’. The sensitivity of a test is also related to its ‘negative predictive value’ (true negatives) – a test with a sensitivity of 100% means that all those who get a negative test result do not have the disease. To judge fully the accuracy of a test, its Specificity must also be considered.

A means of representing uncertainty in the results of economic evaluations. Uncertainty may arise from missing data, imprecise estimates or methodological controversy. Sensitivity analysis also allows for exploring the generalisability of results to other setting. The analysis is repeated using different assumptions to examine the effect on the results.

In diagnostic testing, it refers to the chance of having a negative test result given that you do not have the disease. 100% specificity means that all those without the disease will test negative, but this is not the same the other way around. A patient could have a negative test result yet still have the disease – this is called a ‘false negative’. The specificity of a test is also related to its ‘positive predictive value’ (true positives) – a test with a specificity of 100% means that all those who get a positive test result definitely have the disease. To judge fully the accuracy of a test, its Sensitivity must also be considered.

Survival is the time alive after diagnosis of a disease

A review of the literature carried out in order to address a defined question and using quantitative methods to summarise the results.