Lentz, Ruth A.

Introduction: Outcomes from multidisciplinary lymphoma tumor boards in the molecular era are limited, and the effects of transitioning to virtual formats during the COVID-19 pandemic are not well-documented. This study evaluates how the transition of the Mayo Clinic Lymphoma Tumor Board to a virtual format has impacted its effectiveness and operations. The board, part of the International Mayo Clinic Care Network (MCCN), involves case presentations, subspecialist reviews, and collaborative recommendations. Methods: The Mayo Clinic Lymphoma Tumor Board, an integral part of the Mayo Clinic Care Network (MCCN), conducted a comprehensive review of lymphoma cases from 2014 to 2024. The board's review process involves a structured approach including the presentation of clinical case details, radiology and hematopathology findings, proposed treatment options, relevant literature review, and discussions. From 2014 to 2024, the Mayo Clinic Lymphoma Tumor Board reviewed a total of 722 patients. The review process involves a multidisciplinary team, including physicians, pharmacists, clinical research associates, and trainees. Recommendations and changes related to radiology interpretation, pathologic diagnosis, and treatment approaches were documented and tracked prospectively. In March 2020, the board transitioned to a virtual format due to the COVID-19 pandemic. This shift allowed for remote participation and continued collaborative review while maintaining the board's structured approach and documentation practices. Results: In a total of 722 patients, changes in care were identified in 423 patients, including 287 with newly diagnosed lymphoma and 136 with relapse or refractory disease. Among those who experienced changes, 94 had diffuse large B-cell lymphoma, 49 had follicular lymphoma, 39 had marginal zone lymphoma, 36 had classical Hodgkin lymphoma, and 29 had mantle cell lymphoma. Prior to the COVID-19 pandemic, 431 patients were analyzed, with 217 (50.3%) experiencing changes. A total of 268 changes were documented among these patients. Changes in radiologic interpretation occurred in 9 patients (2.1% of 431 total patients). Pathologic diagnosis changes were noted in 42 patients (9.7%). Additional testing was recommended for 73 patients (16.9%), and clinical management was altered for 144 patients (33.4%). After transitioning to a virtual format, 291 patients were reviewed post-COVID, with 206 (70.8%) having recommended changes. The total number of change recommendations was 322, reflecting increases across all components compared to previous data, with adjustments for varying numbers of patients reviewed. Specifically, radiologic interpretation changes occurred in 21 patients (7.2%), pathologic diagnosis changes in 57 patients (19.6%), additional testing recommendations for 85 patients (29.2%), and clinical management alterations in 159 patients (54.7%). Conclusion: Transitioning to a virtual format in the Mayo Clinic Lymphoma Tumor Board's continued to demonstrate the effectiveness, with increased changes in diagnostic interpretations and clinical management. These results illustrate the potential of virtual tumor boards to improve collaborative decision-making and adapt to evolving clinical needs.

Abstract Introduction: Outcomes of multidisciplinary and molecular tumor boards have been reported. Lymphoma specific tumor board outcomes have not been reported in the molecular era. In addition, the utility of multi-site, interactive tumor boards using videoconference technology are not widely reported. We prospectively followed the outcomes of a multidisciplinary multi-site lymphoma tumor board in the molecular era and during a change in the revision of the World Health Organization Classification in first published in 2016. Methods: The Mayo Clinic Lymphoma Tumor Board is a component of the international Mayo Clinic Care Network (MCCN). The format includes the clinical case presentation, presentation of radiology and hematopathology findings by the appropriate specialist, proposed treatment options, review of the literature pertinent to the case, and discussion followed by recommendations. Requirement for presentation includes having a diagnosis of lymphoma with pathology reviewed at Mayo Clinic, Rochester, MN (MCR). Pathology and radiology material, when relevant to the case, are required to be reviewed at MCR and presented by MCR pathologists/radiologists. Patients must be presented prospectively, and have active clinical issues or questions to be addressed. Four cases are presented per 60-minute meeting. 309 consecutive highly selected cases with a diagnosis of lymphoma were presented at the Mayo Clinic Lymphoma Tumor Board from 2014 to 2018. The pathology material was independently reviewed by the presenting hematopathologists and radiology material by the presenting radiologist. Participants are office based and included multiple members of the health care team which also incudes pharmacists, clinical research associates affiliated with lymphoma research, and physicians in training. Recommendations were prospectively tracked for changes in radiology interpretation, pathologic diagnosis, and treatment approaches. Actual follow-up of all patients after the meeting was not allowed in the MCCN. Participation in the meeting can be either via in-room attendance at MCR, video conference at a participating MCCN site, or via non-participatory live-stream online. Results: 309 cases were presented were presented from 2014-2018. 258 cases were from MCR, and 51 were not physically seen at MCR. 16 cases were presented at a subsequent meeting for further recommendations in the course of their disease after the initial presentation. 54% of patients presented had changes in some aspect of their care as a result of the meeting. Changes in radiologic interpretation occurred in 5 (1.6%) patients. The pathologic diagnosis changed in 27 (8.7%). Additional testing was recommended in 44 (14%). Clinical management changes were recommended in 90 (29%) cases. These included alterations in treatment approach in 43 (14%), change from undecided to pursuit of treatment 10 (3%), change from undecided regarding treatment approach to further diagnostic testing 4 (1.3%), change from observation to treatment 9 (3%), change from treatment to observation 4 (1.3%), and treatment to further tests in 2 (0.6%) Site in room average attendance (internal/external) was 16.8/8.6. Non-participatory live-stream attendance was not possible to track. In an annual electronic evaluation of this activity, 93% of the responders reported an improvement in knowledge and competence, and 100% recommended no changes to the format of the conference. Enhancements over time have included Continuous Medical Education credit, an in room microscope, and real-time radiology images. Selected cases will now be on line on an international web site. Conclusion: In this highly selected group of lymphoma cases from multiple sites over a 4-year period, 54% of the (167/309) case presentations resulted in changes to some aspect of care as a direct result of this tumor board. A multidisciplinary lymphoma tumor board approach was of value, efficacious, and meaningfully impacted lymphoma patients while substantially enhancing interdisciplinary interactions. Disclosures Ansell: Celldex: Research Funding; Seattle Genetics: Research Funding; Takeda: Research Funding; Bristol-Myers Squibb: Research Funding; Pfizer: Research Funding; Merck & Co: Research Funding; LAM Therapeutics: Research Funding; Regeneron: Research Funding; Trillium: Research Funding; Affimed: Research Funding.