Program Operations Manual System (POMS)
TN 41 (10-20)
DI 23022.937 Child Lymphoblastic Lymphoma
COMPASSIONATE ALLOWANCES INFORMATION
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CHILD LYMPHOBLASTIC LYMPHOMA
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ALTERNATE NAMES
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DESCRIPTION
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Child Lymphoblastic Lymphoma is a type of non-Hodgkin lymphoma of the lymphatic system. Child lymphoblastic lymphoma
is similar in etiology to acute lymphoblastic leukemia because lymphoblasts infiltrate
nodal structures of the bone marrow, spleen, and central nervous system. A difference
in this disease is that the tumor may present as a lump in some part of the body,
with the most common location being in the abdomen. Occasionally, it may present as
a lump in a lymph gland, bone, skin, thyroid gland, or the tonsils.
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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 child lymphoblastic lymphoma may include:
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Fine needle aspiration biopsy;
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Bone marrow aspiration and biopsy; and
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Imaging such as ultrasound, MRI, CT scan and PET scan.
Physical findings: Signs and symptoms of childhood lymphoblastic lymphoma may be different depending
on the location of the tumors. Common symptoms may include:
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High fever for no known cause;
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Weight loss of more than 10% of body weight in a short period of time (within 6 months);
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Enlarged liver and kidney;
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Painless swelling of the lymph nodes in the neck, underarm, stomach or groin;
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ICD-9:
200.8
ICD-10: C83.5
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PROGRESSION
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The childhood form of lymphoblastic lymphoma is a disease of rapid onset and progression.
In most cases, the disease has progressed to an advanced stage (stage III or IV) by
the time of diagnosis. The prognosis depends on histology (structure of the affected
tissue); extent of the disease; presence or absence of metastasis; the child’s age;
and response to therapy.
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TREATMENT
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Children with lymphoblastic lymphoma are treated with chemotherapy and radiation,
usually following acute leukemia treatment protocols. Chemotherapy often includes
intrathecal therapy (injection of chemotherapy into the spinal canal). Radioimmunotherapy
is being researched as a possible treatment option.
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SUGGESTED PROGRAMMATIC ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes diagnostic features of the disorder
and laboratory findings are needed to confirm the diagnosis;
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Pediatric oncology consultation reports;
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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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113.06 A
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Must meet listing level severity.
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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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