TN 8 (11-12)

DI 23022.937 Child T-Cell Lymphoblastic Lymphoma

COMPASSIONATE ALLOWANCE INFORMATION

CHILD T-CELL LYMPHOBLASTIC LYMPHOMA

ALTERNATE NAMES

 

DESCRIPTION

Child T-Cell Lymphoblastic Lymphoma is a type of non-Hodgkin lymphoma of the lymphatic system. T-cell 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.

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

Diagnostic testing: Diagnostic testing for child T-cell lymphoblastic lymphoma includes blood and urine tests, surgical biopsy, fine needle aspiration biopsy, bone marrow aspiration and biopsy, ultrasound, MRI, CT, and PET scan.

Physical findings: Signs and symptoms of childhood T-cell lymphoblastic lymphoma may be different depending on the location of the tumors. Common symptoms may include high fever for no known cause; night sweats; weight loss of more than 10% of body weight in a short period of time (within 6 months); enlarged liver and kidney; generalized weakness; painless swelling of the lymph nodes in the neck, underarm, stomach or groin; difficulty breathing; wheezing; and coughing.

ICD-9: 200.8

ONSET AND PROGRESSION

The childhood form of T-cell 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.

TREATMENT

Children with T-cell 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.

SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for evaluation:

  • Clinical history and examination that describes diagnostic features of the disorder and laboratory findings are needed to confirm the diagnosis.

  • Pediatric oncology consultation reports.

  • Imaging studies.

  • Biopsy reports.

  • Pathology reports.

Suggested Listings for Evaluation:

DETERMINATION

LISTING

REMARKS

Meets Listing

113.06A

Must meet listing level severity.

Medical Equals

113.06A

Other child lymphoblastic lymphomas (for example, B-cell lymphoblastic lymphoma).

* 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/0423022937
DI 23022.937 - Child T-Cell Lymphoblastic Lymphoma - 11/30/2012
Batch run: 11/30/2012
Rev:11/30/2012