Effective Dates: 08/31/2020 - Present Previous | Next

TN 35 (08-20)

DI 23022.085 Acute Leukemia

COMPASSIONATE ALLOWANCES INFORMATION

ACUTE LEUKEMIA

ALTERNATE NAMES

Acute Lymphoblastic or Lymphocytic Leukemia (ALL); Acute Myeloid Leukemia (AML)

DESCRIPTION

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. White blood cells fight infection and are generally classified as lymphocytes or as myelocytes depending on their exact form and function. If the growth of the white blood cells involves the lymphoid line, the disease is classified as acute lymphocytic leukemia; that of the myeloid line is classified as acute myeloid leukemia.

DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING

Diagnostic testing: The diagnosis of acute leukemia is made by physical examination and history; complete blood count (CBC); peripheral blood smear; bone marrow aspiration and biopsy; cytogenetic analysis; immunophenotyping; and reverse transcription- polymerase chain reaction test (RT-PCR). Bone marrow testing is definitive.

Physical findings: The early symptoms and signs of acute leukemia may be similar to the flu, and include:

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    Fatigue;

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    Fever;

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    Dyspnea;

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    Weight loss;

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    Bony pain;

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    Bleeding and clotting problems;

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    Swelling in the abdomen;

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    Lumps or spots on the skin; and

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    Enlarged lymph nodes.

ICD-9: 205.00

ICD-10: C91.0

PROGRESSION

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 remission is possible.

TREATMENT

The treatment of acute leukemia is approached in three phases. Induction therapy is the first phase of treatment. Its purpose is to kill the leukemia cells in the blood and bone marrow thereby inducing remission. Post-remission therapy is the second phase of treatment. It begins once the leukemia is in remission and its purpose is to kill any remaining leukemia cells that may not be active but could cause a relapse. This may be followed by the third phase, maintenance therapy, with the goal of preventing 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 and bleeding complications, requiring inpatient stays with IV antibiotics and transfusion support.
SUGGESTED PROGRAMMATIC ASSESSMENT*

Suggested MER for Evaluation:

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    Clinical history and physical examination that describes the diagnostic features of the impairment;

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    Initial and follow-up pathology reports; and

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    Results of bone marrow examination, chromosomal analysis, and crytochemical surface marker studies.

Suggested Listings for Evaluation:
DETERMINATION

LISTING

REMARKS
Meets 13.06 A

Acute leukemia currently meets the criteria in 13.06 A.

113.06 A

 Acute leukemia currently meets the criteria in 113.06 A
Equals ​ ​

* 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.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022085
DI 23022.085 - Acute Leukemia - 08/31/2020
Batch run: 07/20/2021
Rev:08/31/2020