TN 8 (11-12)

DI 23022.921 Adult Non-Hodgkin Lymphoma

COMPASSIONATE ALLOWANCE INFORMATION

ADULT NON-HODGKIN LYMPHOMA

ALTERNATE NAMES

Lymphoma - non-Hodgkin's; Lymphocytic lymphoma; Histiocytic lymphoma; Lymphoblastic lymphoma; Cancer - non-Hodgkin's lymphoma

DESCRIPTION

Adult Non-Hodgkin Lymphoma (NHL) is a type of cancer that starts in the lymphatic system, which in turn allows spread to other organs and tissues in the body. Adult NHL is categorized into three grades:

  • Low grade or indolent: which are slow growing lymphomas

  • Intermediate grade or aggressive and faster growing lymphomas

  • High-grade or highly aggressive and very fast growing lymphomas.

Signs of Adult NHL may include swollen lymph nodes in the neck, armpit or groin; discomfort or feeling of fullness in the abdomen; fatigue; shortness of breath; unexplained fever, night sweats, or weight loss.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM CODING

Diagnostic testing: Diagnostic testing for Adult NHL includes blood chemistry studies, CT scan, PET scan, MRI, bone marrow aspiration and biopsy.

Physical findings: Adult NHL may cause different signs and symptoms, depending on the location of the tumor.

ICD-9: 200.2 (Burkitt lymphoma); 200.5 (Primary CNS lymphoma); 200.6 (Anaplastic large cell lymphoma); 200.7 (Large cell lymphoma); 202.0 (Follicular or lymphocytic lymphoma); 202.7 (Peripheral T-cell lymphoma); 202.8 (Malignant lymphoma NOS)

ONSET AND PROGRESSION

NHL can occur at any age, with the risk of increasing with age. Most people are diagnosed in their 60’s. The prognosis for Adult NHL is dependent on the type and characteristics of the malignant tumor, the growth and location of the tumor, and the spread (metastasis) at the time of diagnosis.

TREATMENT

Adult NHL is mainly treated with chemotherapy, with radiation therapy, or antibody or biological therapy added depending on response to treatment.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation: The adjudicator needs medical evidence from treating sources and hospitals. It should include clinical examination, imaging tests, biopsies, pathology reports, surgical procedures, pertinent treatment records, and up-to-date progress notes.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

13.05 A

Listing level aggressive adult Non-Hodgkin Lymphoma requires that the cancer be recurrent after initial anti-neoplastic treatment. Listing level indolent adult non-Hodgkin lymphoma requires initiation of more than one antineoplastic treatment regimen within a consecutive 12-month period.

Medical Equals

  

* 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.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022921
DI 23022.921 - Adult Non-Hodgkin Lymphoma - 11/30/2012
Batch run: 11/30/2012
Rev:11/30/2012