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Lund deep dive: CLL lives in haematology, lymphoma in oncology, and the second opinion has a written routine

15.1 How SUS is organised

SUS runs haematology, oncology and radiation physics as one division, VO Hematologi, onkologi och strålningsfysik (VO HOS). Within it:

  • Haematology ("Hematologi och koagulation") works in both Lund and Malmö. Its stated regional remit is "i första hand akut leukemi och stamcellstransplantation" (mainly acute leukaemia and stem-cell transplantation), not CLL. The page names Silke Engelholm as head (verksamhetschef) and was last updated 24 April 2026 (SUS Hematologi, archived copy) [E].
  • Lymphoma is treated in oncology, at Onkologimottagning 1 Lund (1177).
  • Elsewhere in Skåne, haematology clinics in Helsingborg and Kristianstad and the Ystad medical clinic also see blood diseases (1177 contact cards).
  • Research capacity (2024 trade-magazine source; Tier 3): SUS has been an accredited Comprehensive Cancer Centre since May 2022, and VO HOS runs a clinical research unit of about 30 staff (Onkologi i Sverige 2/2024).

15.2 Which clinic owns follow-up?

How referrals are routed. Region Skåne's primary-care guideline (in force until 2027) routes suspected lymphoma and KLL like this (AKO Skåne, archived copy) [E]:

  • In the Malmö–Lund catchment (which includes Landskrona and Trelleborg), lymphocytosis goes to haematology in Lund or Malmö, while enlarged nodes without lymphocytosis go to the oncology clinic at SUS Lund.
  • In the north-west and north-east of Skåne, referrals go to the haematology or medical clinics in Helsingborg and Kristianstad.

Primary-care follow-up. The national guideline allows selected stable patients to be followed in primary care, with clear rules for referring them back (VP8.2 ch. 14). No Skåne-wide routine for this was found.

[I] Patients diagnosed from excised nodes may be in the lymphoma pathway. They may have entered through oncology and later be handed to haematology. If that is how the diagnosis was made, ask outright:

  • which clinic will follow you;
  • who your named doctor and contact nurse are;
  • if follow-up stays in oncology, how KLL expertise (Roth or Lindblad) will be involved.

15.3 Haematopathology and molecular diagnostics

Region Skåne's Klinisk genetik, patologi och molekylär diagnostik has about 450 staff, according to a job advert (Tier 3) [E].

  • Pathology runs in Lund, Malmö, Helsingborg and Kristianstad.
  • Genetics and molecular diagnostics are concentrated in Lund.
  • The CLL genetic tests (FISH, TP53, IGHV) are run in-house in Lund (section 6.3).
  • Accreditation: ISO 15189 (Swedac 1309). No ERIC certification is listed.
  • Gene panels: the national GMS lymphoid panel "ännu inte något som rekommenderas i klinisk rutin" (is not yet recommended in routine care) (VP8.2 §8.4.6).
  • Registry history: the registry attributes the southern region's historical under-reporting of early-stage CLL to flow cytometry being done in clinical-chemistry labs; the region has since reorganised.

15.4 Multidisciplinary conferences

  • CLL: the guideline says multidisciplinary conferences are "sällan nödvändiga" (rarely necessary). A haematopathology conference is "av värde" (of value) when there is doubt, and discussion with regional KLL expertise is encouraged in later stages (VP8.2 ch. 9).
  • SVF: the pathway's therapy conference (block G) need not include untreated KLL (SVF v3.3).
  • SUS: the schedule of the lymphoma/KLL conference was not verified.

15.5 Trials at Lund

CLL18/MOIRAI recruits at Lund [E]:

  • What it is: a first-line phase 3 trial.
  • Registries: listed in the EU trial register CTIS (Swedish decision 2 July 2026; Lund contact Oscar Lindblad) and in RCC's study database (updated 6 October 2026) (CTIS; RCC CLL18).
  • Not on ClinicalTrials.gov: CLL18 has no record there, so on ClinicalTrials.gov alone it looks as if only relapsed-disease trials recruit at Lund.
  • Not knowable from registries: whether Lund is enrolling patients today, since no register reports site-level enrolment.

Other CLL trials at Lund:

  • CELESTIAL-RRCLL (relapsed disease) is the only other trial recruiting there.
  • Several earlier trials are active but no longer recruiting: CLL17, SEQUOIA, ELEVATE-TN, BRUIN CLL-322 and extension studies (ClinicalTrials.gov, CLL + Lund).

15.6 Referral, self-referral, second opinion and contact nurse

Access to haematology [E]. All four Skåne haematology clinics accept a referral (remiss) or a self-referral (egen vårdbegäran) through 1177 (1177 Hematologimottagning Lund). Skåne has no doctor-referral requirement for most clinics.

Region Skåne's written routine for second opinions [E]. "Tillämpningsanvisningar – Remisshantering i Region Skåne", version 2.0, approved 3 April 2025 (archived copy), says:

  • "Den som ansvarar för patienten ska informera om möjligheten att få ny medicinsk bedömning samt medverka till att hen får en ny medicinsk bedömning" (whoever is responsible for the patient must inform them about, and help them obtain, a new medical assessment).
  • "Det är hälso- och sjukvårdspersonalens bedömning som ligger till grund för om en ny medicinsk bedömning kan bli aktuell" (the clinicians' assessment decides whether one is warranted).
  • "Second opinion" is not a defined term and "ska inte användas synonymt med Ny medicinsk bedömning" (must not be used as a synonym for ny medicinsk bedömning).
  • Citing the bill behind the Patient Act, nothing prevents staff from helping even when the formal duty is not triggered.

A newer version, approved 24 June 2026, exists; its content is not verified.

Care outside Skåne [E]. "I Region Skåne är det endast verksamhetschef på offentligt bedrivet sjukhus som kan godkänna och skriva under en Remiss/Betalningsförbindelse" (only the head of a public hospital unit can approve and sign a referral that is also a payment commitment) (Vård i andra regioner, archived copy).

Contact nurse.

  • The national standard: every KLL patient "ska, om behov finns, erbjudas en fast namngiven kontaktsjuksköterska" (shall, if needed, be offered a named contact nurse) (VP8.2 §18.1).
  • None of Skåne's haematology contact cards mentions one, and a named KLL contact nurse at SUS could not be verified.
  • Patients can insist on a fast vårdkontakt (permanent care contact) under PL 6 kap. 2 §.

Centralisation. [I] CLL is not formally centralised to SUS. In practice, complex and relapsed disease gravitates to Lund, where transplantation and trials are.

15.7 Mats Jerkeman and lymphoma expertise in Lund

The evidence [E]:

  • Mats Jerkeman is a professor and senior oncology consultant in Lund and a leading lymphoma trialist: principal investigator for Nordic Lymphoma Group trials in mantle cell lymphoma and DLBCL.
  • He co-authored the ESMO 2024 CLL interim update. That most plausibly reflects his role as an ESMO guideline editor, which is not verified.
  • He is not, and never has been, a member of the national KLL guideline group, and he is not on the registry steering group.
  • He holds no CLL trial-PI role, has 7 CLL publications, and is not an author of the EHA 2026 CLL guideline that succeeds ESMO's.

[I] CLL-specific contacts in Lund. For a CLL-specific opinion, Daniel Roth (the region's official CLL representative in both national bodies) and Oscar Lindblad (guideline co-author, CLL17 author, CLL18 site contact) are more disease-specific. Neither has Jerkeman's academic stature or publication record.

Where Jerkeman fits. He, the oncology lymphoma team and the Lund haematopathologists are the right people if the histology raises a lymphoma differential (mantle cell or marginal-zone lymphoma) or possible transformation.

[I] Independence. A formal ny medicinsk bedömning gains independence when it comes from a different team, and ideally a different region.