Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.085 Acute Leukemia
COMPASSIONATE ALLOWANCE INFORMATION
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. The early symptoms and signs of acute leukemia may be similar to the flu, and include fatigue, fever, dyspnea, weight loss, bony pain and petechiae (flat pinpoint spots under the skin caused by bleeding).
Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia
DIAGNOSTIC TESTING AND CODING
To diagnose acute leukemia the following may be done: physical exam and history, complete blood count (CBC), peripheral blood smear (procedure in which a sample of blood is checked for the presence of blast cells, number and kinds of white blood cells, the number of platelets and changes in the shape of blood cells), bone marrow aspiration and biopsy, cytogenetic analysis and immunophenotyping. To definitively determine the diagnosis, a bone marrow examination is necessary.
The treatment of acute leukemia is done in phases. Induction therapy is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow. The goal of this treatment is to induce remission. Post-remission therapy is the second phase of treatment. It begins once the leukemia is in remission. The purpose of post-remission therapy is to kill any remaining leukemia cells that may not be active but could begin to regrow and cause 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 complications.
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 cures are possible.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: A bone marrow exam is necessary for definitive diagnosis.
Suggested Listings for Evaluation:
13.06 A or 113.06 A
Acute leukemia currently meets Listings 13.06 A or 113.06 A.
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.
Last Updated: 9/30/08
Office of Disability Programs