Program Operations Manual System (POMS)
TN 35 (08-20)
COMPASSIONATE ALLOWANCES INFORMATION
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ACUTE LEUKEMIA
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ALTERNATE NAMES
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Acute Lymphoblastic or Lymphocytic Leukemia (ALL); Acute Myeloid Leukemia (AML)
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DESCRIPTION
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Acute Leukemia is a rapidly progressing cancer that starts in the blood-forming tissue such as the
bone marrow, and causes large numbers of white blood cells to be produced and enter
the blood stream. White blood cells fight infection and are generally classified as
lymphocytes or as myelocytes depending on their exact form and function. If the growth
of the white blood cells involves the lymphoid line, the disease is classified as
acute lymphocytic leukemia; that of the myeloid line is classified as acute myeloid
leukemia.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND
ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: The diagnosis of acute leukemia is made by physical examination and history; complete
blood count (CBC); peripheral blood smear; bone marrow aspiration and biopsy; cytogenetic
analysis; immunophenotyping; and reverse transcription- polymerase chain reaction
test (RT-PCR). Bone marrow testing is definitive.
Physical findings: The early symptoms and signs of acute leukemia may be similar to the flu, and include:
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Bleeding and clotting problems;
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Lumps or spots on the skin; and
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ICD-9: 205.00
ICD-10: C91.0
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PROGRESSION
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Children and adults with acute leukemia need to be treated immediately. Many times
clinical remissions are seen, and in a smaller number of individuals, long-term remission
is possible.
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TREATMENT
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The treatment of acute leukemia is approached in three phases. Induction therapy is
the first phase of treatment. Its purpose is to kill the leukemia cells in the blood
and bone marrow thereby inducing remission. Post-remission therapy is the second phase
of treatment. It begins once the leukemia is in remission and its purpose is to kill
any remaining leukemia cells that may not be active but could cause a relapse. This
may be followed by the third phase, maintenance therapy, with the goal of preventing
a relapse. Chemotherapy is the mainstay of treatment used during these phases. It
involves the use of a regimen of high-dose, intense drugs and in the case of acute
lymphoblastic leukemia, direct installation of chemotherapy into the spinal fluid
is used. Also, high-dose stem cell transplantation may be performed. Commonly, individuals
develop severe infectious and bleeding complications, requiring inpatient stays with
IV antibiotics and transfusion support.
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SUGGESTED
PROGRAMMATIC ASSESSMENT* |
Suggested MER for Evaluation:
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Clinical history and physical examination that describes the diagnostic features of
the impairment;
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Initial and follow-up pathology reports; and
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Results of bone marrow examination, chromosomal analysis, and crytochemical surface
marker studies.
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Suggested Listings for
Evaluation: |
DETERMINATION |
LISTING
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REMARKS |
Meets |
13.06 A |
Acute leukemia currently meets the criteria in 13.06 A.
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113.06 A
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Acute leukemia currently meets the criteria in 113.06 A |
Equals |
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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