Preparing T-cell lymphoma records for referral: documenting the diagnosis and each treatment line

A records package should help the receiving clinician locate the information that changes a decision. The first page can give age, current city or country, the full pathological diagnosis, the most recent treatment date and the question for consultation. Examples include clarification of a nodal TFH-cell lymphoma classification or next-line planning after progression on a specified regimen. A sequence of unlabelled photographs in a message thread leaves the clinician to reconstruct the purpose.

Key takeaways

These excerpts come from the original article. Read the full sections below for context.

Provide the complete pathology report, including the sampled site, date, accession number, morphology, immunohistochemistry, other investigations and final interpretation with comments. Retain supplementary and consultation reports alongside the original. The CAP guideline emphasizes appropriate specimens and integrated ancillary findings, which explains why the final diagnostic sentence alone may not allow another pathologist to understand the basis of classification. CAP/ASCP: Laboratory Workup of Lymphoma in Adults guideline
Serious infection, infusion reactions, persistent numbness, severe mouth inflammation, cardiac changes or suspected drug-related liver injury may influence future choices. Record the medicines in use at the time, whether admission was required, the response taken and subsequent recovery. Distinguish allergy from other intolerance where the original clinician has done so. Labelling every episode of nausea as an allergy can be misleading, while omitting a reaction that required emergency treatment can be hazardous.
Keep a personal copy of the package and a short list of questions for the appointment. A family member can help navigate the files, but the patient should know what has been shared and which issue the consultation is expected to address. If a new result arrives after submission, send a clearly identified update rather than editing the old summary without marking the change.

Quick answer

Full guide

Use the first page to identify the current question

The overview should be concise while remaining separate from the original records. Organize materials into diagnosis, investigations, treatment and current status, preserving dates and issuing institutions. The disease entity, extent, previous therapy and fitness addressed in the ESMO–EHA guideline are also core referral information. Families do not need to interpret every technical term; faithful preservation is more useful than replacing the record with their own conclusion. d’Amore et al.: ESMO–EHA guideline for peripheral T- and NK-cell lymphomas, 2025

Make pathology traceable to the actual tissue

Provide the complete pathology report, including the sampled site, date, accession number, morphology, immunohistochemistry, other investigations and final interpretation with comments. Retain supplementary and consultation reports alongside the original. The CAP guideline emphasizes appropriate specimens and integrated ancillary findings, which explains why the final diagnostic sentence alone may not allow another pathologist to understand the basis of classification. CAP/ASCP: Laboratory Workup of Lymphoma in Adults guideline

Slides, tissue blocks and unstained sections are different materials. Ask the receiving laboratory what it needs, how much and by what route before arranging release or duplication at the original hospital. Keep an inventory of accession numbers so tissue from different dates or sites is not mixed. Record any return requirements. Relatives should not scrape, divide, re-fix or otherwise manipulate specimens themselves.

Preserve changes in disease terminology

Classification can change when additional evidence becomes available. The International Consensus Classification places several nodal TFH-derived tumors within a related framework, so older and newer reports may not use identical wording. Note when and where a diagnosis was revised, but keep the previous report. Do not replace all earlier terms in the source documents with a new name as though that diagnosis had always been established. Campo et al.: International Consensus Classification of Mature Lymphoid Neoplasms, 2022

Retain the original wording and methods for CD30, ALK, TFH markers, EBER and T-cell receptor clonality when performed. A positive result does not independently establish every diagnosis or imply that a corresponding drug must be suitable. If interpretation is stated to depend on morphology or clinical context, preserve that statement. Selecting only apparently favorable results removes information the receiving team needs to assess uncertainty.

Include the complete molecular report

For gene or other biomarker testing, retain specimen type, collection date, method, detected findings and explanatory limitations. Tumor testing and testing for an inherited disorder answer different questions. A variant in a tumor report should not be translated by the family into a diagnosis of inherited disease. NCI's biomarker-testing information also explains that results do not always identify an effective matched treatment. NCI: Biomarker Testing for Cancer Treatment

Suggested drugs or trials in a commercial report can be provided for discussion, but should remain distinct from the confirmed diagnosis and local indication. Reducing the report to a list of available targeted drugs can conceal the strength of evidence and sample limitations. When a report is long, an intact PDF is generally easier to review than a sequence of separate photographs, especially if the interpretation spans several pages.

Supply original images and their treatment context

Where available, include baseline, important interim and most recent imaging reports with the original studies exported by the hospital. DICOM data permit review across image slices; a phone photograph of film or several selected PET hotspots usually cannot replace the full examination. Label whether each study preceded, occurred during or followed a treatment line, and note relevant recent infection or therapy. Cheson et al.: Lugano classification for lymphoma evaluation and response

If two institutions report different responses, preserve both rather than choosing one conclusion yourself. The PRoLoG consensus discusses practical application of Lugano assessment, including consistency and uncertain findings. The new clinician needs to know which study was baseline, which lesions were followed and whether repeat imaging or biopsy was recommended. That context can matter as much as the response abbreviation in the conclusion. PRoLoG Consensus Initiative: clinical application of Lugano assessment

Keep marrow, blood and viral results distinguishable

Bone-marrow aspirate, biopsy, flow cytometry and molecular reports should be retained separately when available. PET and marrow studies may provide different information; the 2025 CHEMO-T substudy describes discordance in PTCL. A negative result in one modality is not a reason to remove an abnormal result from the other from the summary. Present the disagreement accurately and leave its interpretation to the clinical team. CHEMO-T investigators: PET/CT substudy in peripheral T-cell lymphoma, 2025

Laboratory reports should retain dates, units and reference intervals, particularly for blood counts, LDH, renal and liver function and tests relevant to current treatment. For hepatitis viruses, HIV, EBV or HTLV-1, identify whether testing concerned antibody, antigen or nucleic acid and the specimen used. Do not compress distinct findings into virus positive. WHO's HTLV-1 information distinguishes infection from its associated diseases, illustrating why the specific test needs clinical interpretation. WHO: Human T-lymphotropic virus-1, December 2025

Describe every treatment line as a verifiable sequence

For each line, record the regimen, generic drug names, starting and finishing dates, completed cycles, important modifications, best response and subsequent change. Saying that chemotherapy was given several times makes it difficult to identify prior exposure, resistance or a toxicity-related stop. Link key statements to prescriptions, discharge summaries or response reports wherever possible rather than turning uncertain recollection into a precise date.

For care received in different countries, preserve the relationship between brand and generic names and whether a medicine was used alone or with other agents. China's national guidance contains different disease- and setting-specific entries for some drugs; an accurate history helps clinicians assess the next proposal. Document dose changes from actual prescriptions. Families should not fill missing values using a standard regimen found online. 中国国家卫生健康委：《新型抗肿瘤药物临床应用指导原则（2025年版）》，2026-01-26发布

Give major adverse events their own section

Serious infection, infusion reactions, persistent numbness, severe mouth inflammation, cardiac changes or suspected drug-related liver injury may influence future choices. Record the medicines in use at the time, whether admission was required, the response taken and subsequent recovery. Distinguish allergy from other intolerance where the original clinician has done so. Labelling every episode of nausea as an allergy can be misleading, while omitting a reaction that required emergency treatment can be hazardous.

If mogamulizumab has been used and an allogeneic transplant may be considered, make the exposure dates easy to find. Its 2026 prescribing information identifies serious risks after subsequent allogeneic transplantation, so this history should not be buried among many prescription pages. For brentuximab vedotin, document the severity and recovery of relevant neuropathy rather than simply saying that an antibody medicine was received. DailyMed: POTELIGEO mogamulizumab prescribing information, February 2026 ADCETRIS: current US prescribing information, Pfizer

Obtain dedicated transplant and radiation summaries

After transplantation, include type, date, conditioning regimen, cell source, an appropriate donor and matching summary, graft-versus-host disease, major infections and current immunosuppressive treatment. EBMT's follow-up material addresses immune recovery and multiple organ systems. The phrase successful transplant does not give a new hospital enough information to continue care. Ask the transplant service for its formal summary and outstanding monitoring requirements. Suárez-Lledó and Rovira: Follow-up after HCT, EBMT Handbook 2024

Radiotherapy records should identify the treated site, start and finish dates, total dose, number of fractions and available planning information from the original radiation service. These details matter when later symptoms or further irradiation are being assessed. A recollection that radiation lasted several weeks is less useful. If the record is unavailable, mark it as requested rather than substituting values from a common treatment schedule.

Update the current medication list before each referral

List medicines currently taken or injected, using generic names, prescribed dose and frequency, purpose and the prescribing service. Separately identify recently discontinued medicines that may still affect the next decision. Include infection prophylaxis, corticosteroids, immunosuppressants, anticoagulants and supplements as well as anticancer treatment. A drug prescribed in the past should not remain in the current list after it has been stopped.

For travel, prepare a short version available in hand luggage and an electronic backup. CDC guidance for immunocompromised travelers highlights medicine planning and access to care, so storage information and clinical contacts may also be useful. The list is an account of the patient's prescription. It does not authorize relatives or other patients to adopt the same regimen. CDC Yellow Book 2026: Immunocompromised Travelers

Translation must retain uncertainty, negatives and units

Translation errors that change a decision may be small: positive versus negative, suspected versus confirmed, previously used versus currently prescribed, or a missing unit. Supply the original with the translation and have the key content checked by someone able to understand its medical meaning. Use an unambiguous year-month-day date format and generic medicine names to reduce confusion between national brand names and date conventions.

If handwriting cannot be read, mark it as unclear and ask the issuing service instead of guessing from context. Machine translation can assist preliminary organization, but should not silently replace a specialized term with an approximate one. A patient's own description of symptoms can remain in ordinary language with its date and effect on daily life. Making the account sound technical is less important than keeping it accurate.

Check readability and the receiving route

Open each file to check that it is readable, complete and belongs to the same patient. Confirm that images can be shared in a format accepted by the hospital. Simple filenames containing date, investigation and institution can be supported by a contents page. Identify later additions with an update date, so repeated submissions do not create several conflicting versions of the same history. List missing documents and their request status.

Use an official hospital channel and understand who receives the records and how they will be used. NCI's guidance on trustworthy health information includes attention to source identity and personal-data handling. An enquiry about a service does not require posting identity documents, an address and the entire medical history in a public group. Provide identity information through the hospital's corresponding process when it is needed for formal care. NCI: How to Find Cancer Resources You Can Trust, 2025

Make the handover useful to the patient as well

Keep a personal copy of the package and a short list of questions for the appointment. A family member can help navigate the files, but the patient should know what has been shared and which issue the consultation is expected to address. If a new result arrives after submission, send a clearly identified update rather than editing the old summary without marking the change.

A well-prepared record shows how the diagnosis was reached, what treatment was actually delivered, what has changed now and what the patient wants help deciding. Dates and traceable source documents reduce repeated questioning and make the next consultation more focused. The quality of the package lies in its accuracy and organization, not in the number of pages or the use of elaborate medical language.