Program Operations Manual System (POMS)
TN 45 (08-21)
DI 23022.283 Refractory Hodgkin Lymphoma
COMPASSIONATE ALLOWANCES INFORMATION
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REFRACTORY HODGKIN LYMPHOMA
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ALTERNATE NAMES
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Intractable Hodgkin Lymphoma; Refractory HL; Refractory Hodgkin Disease; Refractory
Hodgkin's Lymphoma; Refractory Hodgkins Lymphoma; Relapsed Hodgkin Lymphoma; Relapsed
Hodgkin's Lymphoma; Relapsed Hodgkins Lymphoma; Relapsing Hodgkin's Lymphoma; Relapsing
Hodgkins Lymphoma
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DESCRIPTION
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Refractory Hodgkin Lymphoma (RHL) is a type of cancer affecting the lymphatic system which either does not respond
to treatment or recurs within a year of successful treatment.
Patients with RHL will have previously been diagnosed with classical Hodgkin Lymphoma
(HL) and received treatment. Cancer that resists treatment (Refractory) or returns
following remission (Relapse) is categorized as RHL.
Hodgkin Lymphoma is distinguished from other lymphomas primarily by the presence of
giant cells known as Reed-Sternberg cells.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM
CODING
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Diagnostic testing: Diagnostic testing for RHL may include:
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Lymph node biopsy showing Reed-Sternberg cells;
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Bone marrow biopsy or aspiration; and
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Imaging studies as CT, MRI, and positron emission tomography (PET).
Physical findings: Physical symptoms of HL and RHL vary, but commonly include:
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Swollen lymph nodes in the neck, armpit, or groin;
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Discomfort or feeling of fullness in the abdomen;
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Unexplained fever, night sweats, or weight loss.
ICD-9: 201
ICD-10: C81
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PROGRESSION
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The prognosis is poor for HL patients who do not achieve full remission after completing
their initial course of treatment, or sustain remission for one year. Approximately
1 in 4 HL diagnoses progress to RHL.
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TREATMENT
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Treatment of RHL typically consists of salvage chemotherapy, followed by autologous
stem cell transplant. The approach to treatment may vary depending on the timing of
the relapse, age of individual, general health of the individual, and previous responses
to treatment.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history confirming diagnosis of Hodgkin Lymphoma, and documenting unsuccessful
treatment or relapse within one year of completing initial treatment.
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Suggested Listings for Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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13.05 B and C
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RHL, by definition, meets 13.05 B. Most RHL patients will also meet 13.05 C.
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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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