Program Operations Manual System (POMS)
TN 1 (10-08)
DI 23022.140 Chronic Myelogenous Leukemia (CML) - Blast Phase
COMPASSIONATE ALLOWANCE INFORMATION
CHRONIC MYELOGENOUS LEUKEMIA (CML) - BLAST PHASE
Chronic Myelogenous Leukemia (CML) is classified by phase: chronic, accelerated and blast phases. The accelerated and blast phases of CML refer to those phases of the disease when increased immature white blood cells (blasts) are made and do not mature. When this happens, the disease behaves similarly to acute leukemia. Symptoms include fever: night sweats, bone pain and weight loss. When tiredness, fever, and an enlarged spleen occur during the blast phase, it is called blast crisis.
Chronic Myeloid Leukemia (Blast phase), CML (Blast phase), Chronic Granulocytic Leukemia (Blast phase)
DIAGNOSTIC TESTING AND CODING
CML is diagnosed with tests and procedures such as: complete blood count (CBC), bone marrow aspiration and biopsy, cytogenic analysis of the blood and/or bone marrow and reports that address the Philadelphia chromosome and molecular assay of the blood or bone marrow looking for bcr-abl gene. In order to diagnose the blast phase at least 20% of peripheral white blood cells or nucleated bone marrow cells must be blasts.
Treatment of CML has improved with the use of tyrosine kinase inhibitors which block the action of this molecule and its effects on white blood cell production. Standard chemotherapy agents are used along with immunotherapy (interferon) and bone marrow transplantation.
Blast phase is the final phase in the evolution of CML. It behaves like acute leukemia with rapid progression and short survival.
SUGGESTED PROGRAMMATIC ASSESSMENT*
Suggested MER for Evaluation: Results of a Complete Blood Count (CBC) exam and bone marrow examinations.
If necessary, cytogenetic (chromosome) studies and molecular analyses can provide additional confirmative information.
Suggested Listings for Evaluation:
13.06 B 1
Chronic Myelogenous Leukemia, blast phase currently meets Listing 13.06 B 1
* 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
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