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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Leukemia


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Maximum Medical Improvement | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
208.00 - Acute Leukemia of Unspecified Cell Type, without Mention of Having Achieved Remission; Failed Remission
208.01 - Leukemia, Unspecified Cell Type, Acute; in Remission
208.10 - Leukemia, Chronic, without Mention of Having Achieved Remission; Failed Remission
208.11 - Leukemia, Chronic, with Remission
208.20 - Leukemia, Subacute, without Mention of Having Achieved Remission; Failed Remission
208.21 - Leukemia, Subacute, with Remission
208.80 - Leukemia, Unspecified Cell Type, Other; without Mention of Having Achieved Remission; Failed Remission
208.81 - Leukemia, Unspecified Cell Type, Other; in Remission
208.90 - Unspecified Leukemia, without Mention of Having Achieved Remission; Failed Remission
208.91 - Leukemia, Unspecified; Leukemia NOS; in Remission

Related Terms

  • Acute Leukemias of Ambiguous Lineage
  • Acute Myeloid Leukemia
  • Adult T-cell leukemia
  • Aggressive Natural Killer Cell Leukemia
  • Atypical Chronic Myelogenous Leukemia, BCR-ABL-1 Negative
  • B-cell prolymphocytic leukemia
  • Chronic Eosinophilic Leukemia (CEL)
  • Chronic Lymphocytic Leukemia/Small Lymphocytic Leukemia
  • Chronic Myeloid Leukemia
  • Chronic Myelomonocytic Leukemia
  • Hairy cell leukemia
  • Juvenile Myelomonocytic leukemia
  • Precursor B-cell lymphoblastic leukemia
  • Precursor T-cell lymphoblastic leukemia
  • T-cell Large Granular Lymphocyte Leukemia
  • T-cell Prolymphocytic Leukemia

Overview

Leukemia is a cancer (malignancy) of the bone marrow in which large numbers of abnormal, poorly functioning white blood cells are produced.

Blood is made up of fluid called plasma and three types of cells that each have special functions: white blood cells (WBCs), red blood cells (RBCs), and platelets. WBCs, an important component of the immune system, help the body fight infection and disease; RBCs carry oxygen from the lungs to the body's tissues and take carbon dioxide from the tissues back to the lungs; and platelets are part of the complex coagulation mechanism, helping to form blood clots when needed to control bleeding. Under normal conditions, blood cells are produced in bone marrow in an orderly, controlled way as the body needs them. However, when produced by leukemia, the cancerous white blood cells remain mainly in the bone marrow and the blood stream. Occasionally a collection of cancerous white blood cells may form a solid tumor mass somewhere other than the bone marrow, but the cells are by no means distributed as they should be.

New or immature blood cells (blasts) are formed in the bone marrow from stem cells (hematopoietic stem cells) and are released into the circulatory system when they are about 24 hours old, where they mature and eventually die (cell apoptosis). Circulating blood normally contains five types of mature WBCs (neutrophils, eosinophils, basophils, monocytes, and lymphocytes) that perform different functions. In leukemia, one of these types and stages of maturation of white blood cells undergoes a malignant transformation that produces poorly differentiated white cells (the "cancer"). These leukemic cells also do not die as programmed, allowing them to accumulate.

The five types of WBCs arise from two primary white blood cell lines. The myeloid line develops into neutrophils, eosinophils, basophils, and monocytes. The lymphoid line develops into lymphocytes and plasma cells. Leukemias involving the myeloid line are referred to as myelogenous leukemia. Leukemias involving the lymphoid line are referred to as lymphoid (lymphoblastic or lymphocytic) leukemia. In the course of leukemia, the rapid proliferation of abnormal white blood cells and the reduced ability of these cells to mature and die, normally, leads to their accumulation in the bone marrow. This accumulation can result in bone marrow failure, shutting down the production of normal cells. Leukemic cells carried by the blood may also infiltrate the liver, spleen, skin, and lymph nodes as well as the spine and central nervous system, ovaries, testicles, and kidneys. Pressure from increased cell activity within the bone marrow may result in bone or joint pain.

Each type of leukemia is categorized according to acuteness and the type of white blood cell affected. The 2008 World Health Organization classification (Swerdlow) is the now preferred classification system. The four most common forms are acute lymphoblastic leukemia, acute myeloid leukemia, chronic myeloid leukemia, and—the most common—chronic lymphocytic leukemia.

Incidence and Prevalence: There are an estimated 274,930 people living with, or in remission from, leukemia in the US. In 2011, 44,600 people are expected to be diagnosed with leukemia. The incidence rates for leukemia are 13/100,000 population in whites, and 7/100,000 in other races. In 2011, the number of people expected to die from leukemia is 21,780. Approximately 31% more males are living with leukemia than females, just as more males than females are diagnosed with leukemia and die of leukemia. Leukemia causes almost one-third of all cancer deaths in children and adolescents younger than 15 years.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Risk factors for leukemia include exposure to high levels of radiation (such as a nuclear event or massive doses of radiation treatment, but not diagnostic x-rays or radiation from electromagnetic fields) and exposure to chemical or environmental carcinogens such as benzene, formaldehyde, and petrochemicals. Smokers have a small increased risk of developing acute myeloid leukemia compared to nonsmokers (Seiter, "AML"). Receiving chemotherapy to treat a previous cancer can increase the risk of developing leukemia. For example, 0.2% to 1.0% of individuals with breast cancer who received specific chemotherapeutic agents were diagnosed with acute myeloid leukemia in the first five years after treatment (Seiter, "AML"). However, most cases of leukemia develop with no identifiable link to a risk factor.

Individuals with a history of aplastic anemia or other blood disorders (antecedent hematologic disorders), or diseases of the bone marrow, such as myelodysplastic syndromes (MDS), are at greater risk of developing acute myeloid leukemia (Seiter, "AML").

Individuals with certain chromosomal abnormalities such as Down syndrome or Klinefelter's syndrome are at increased risk of developing leukemia. Abnormal gene expression related to certain chromosomal changes (translocations) may also increase the risk of adults developing certain leukemias. Familial syndromes related to gene mutations, and hereditary cancer syndromes such as Li-Fraumeni syndrome, can also predispose individuals to developing AML (Seiter, "AML").

Chronic lymphocytic leukemia primarily affects middle-aged to elderly adults, including about 30% who are younger than age 65, with increasing incidence over age 65. Risk is increased in about 5% to 10% of individuals with a family history of the disease, and whites are affected slightly more than blacks (Grever). Acute lymphoblastic leukemia is most common in children and develops less commonly in adults between the ages of 30 and 60 (Seiter, "ALL"). The risk of acute myeloid leukemia increases with age; this type of leukemia affects primarily older adults, with a median age of 70 (Seiter, "AML"). Chronic myeloid leukemia primarily affects middle-aged adults. Regardless of type, leukemia affects males at nearly twice the rate of females (Seiter, "AML"). The risk of a subtype of acute myeloid leukemia known as acute promyelocytic leukemia (APL) is higher in younger adults (median age 31) and in Hispanics, especially those who have a coagulation disorder (Freireich).

Source: Medical Disability Advisor



Diagnosis

History: In acute leukemia, symptoms appear and get worse quickly, sometimes in just a few days or within one or two weeks before diagnosis. Other individuals may develop symptoms over a period of months. Individuals with this disease go to their doctor because they feel sick. They may have noticed general symptoms, such as weight loss, loss of appetite, headache, dizziness, fatigue, or frequent infection. In chronic leukemia, symptoms may not appear for a long time, and when they do appear, they are generally mild at first and worsen gradually.

Chronic leukemia is generally discovered during a routine checkup before there are any symptoms. Symptoms may include generally feeling ill (malaise); fever, chills, and other flu-like symptoms; night sweats; weakness and fatigue; weight loss; loss of appetite; abdominal pain; vomiting; frequent infections; easy bleeding and bruising; severe nosebleeds and swollen or bleeding gums; shortness of breath; bone and joint pain; blurred vision and difficulty maintaining balance; and / or seizures.

Physical exam: Individuals may present with gum enlargement, enlarged and tender lymph nodes most often in the underarms, groin, or neck areas; and an enlarged liver (hepatomegaly) and / or spleen (splenomegaly), indicating organ infiltration with leukemic cells. If reduced platelets (thrombocytopenia) or other coagulation problems are present, tiny pinpoint red spots (petechiae) or larger purple discolorations (purpura) under the skin may be found, especially on the lower extremities. Fever and other signs of infection, including signs of pneumonia, may be present. If anemia is present, individuals may appear pale, and the reduced numbers of red blood cells and reduced delivery of oxygen to tissues may cause shortness of breath. In AML, a cardiac flow murmur may be present as a sign of anemia. Respiratory distress and alterations in mental state may be noted as signs of organ infiltration by leukemic cells.

Tests: Although blood tests may reveal that an individual has leukemia, they may or may not show what type of leukemia it is. A complete blood count (CBC) with differential (peripheral blood smear) will show abnormalities consistent with leukemia, including the number, appearance, and maturity of WBCs. The number of cells that are blasts (immature white blood cells) is especially important to diagnosis; if more than one-third of cells are blasts, it suggests a diagnosis of acute leukemia. The RBC count, hemoglobin, hematocrit, and platelet count may be decreased. Blood chemistries will also be performed to help determine related liver or kidney problems and to serve as a baseline for comparison during eventual treatment and disease monitoring.

Bone marrow aspiration and biopsy are usually performed to identify marrow cells and determine the type of leukemia. A sample of bone marrow is removed with a needle (bone marrow aspiration) and examined under the microscope. A bone marrow biopsy, performed with a larger needle, involves removing a small piece of bone and bone marrow together. The number of blast cells in bone marrow can range between 20% to 90% (Freireich). If leukemia cells are found in the bone marrow sample, a spinal tap (lumbar puncture) may be performed to check for leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord (cerebrospinal fluid).

Cytochemistry techniques are used to examine cells microscopically after they have been stained using special stains. By highlighting cell characteristics, such as granules or abnormal shapes and sizes, specific types of WBCs can be identified in peripheral blood, bone marrow, cerebrospinal fluid, and lymph gland samples to help confirm the diagnosis. Flow cytometry may also be used to examine cells obtained from the blood, the bone marrow, or lymph glands and to determine their immunophenotypes. This technique treats cells with certain antibodies and examines them with laser beams. Because each antibody only adheres to specific antigens on cell surfaces, the method can identify cell types to accurately determine the type of leukemia.

Chromosomal studies on bone marrow samples (cytogenetic studies) provide further information. A variety of familial and acquired chromosome abnormalities are associated with the diagnosis and prognosis of leukemia.

Genetic profiling of leukemic cells can help identify mutated genes that may indicate a more favorable or less favorable clinical course in individuals with chronic lymphocytic leukemia. Genetic abnormalities can be detected using fluorescent in situ hybridization (FISH) analysis; more than 80% of individuals with chronic lymphocytic leukemia are found to have specific biomarkers on leukemic cells that predict a better response to therapy (Grever).

Human leukocyte antigen (HLA) and DNA typing may be done if an individual is being considered for bone marrow transplantation.

Chest x-rays may be performed to evaluate possible lung or cardiac involvement. Imaging studies such as computed tomography scanning (CT) may be used only to evaluate lymph gland involvement and organs that may be affected. Ultrasound is also sometimes used to visualize changes in the kidneys, liver, or spleen. In types of leukemia in which the lymph glands may be affected, such as chronic lymphocytic leukemia, biopsies of lymph nodes may be done to examine lymph cells. Multiple gated acquisition (MUGA) scans are performed in individuals with confirmed acute myeloid leukemia because of a high likelihood of heart problems associated with use of cardiotoxic chemotherapy agents (Seiter, "AML"). Electrocardiography may also be performed before treatment is recommended.

Source: Medical Disability Advisor



Treatment

Treatment for leukemia is based on the type of leukemia diagnosed. Treatment is not the same for all individuals because it is based on certain features of the leukemia cells, the extent of the disease, and whether the leukemia has been treated before. It also depends on the individual's age, symptoms, and general health.

Acute leukemia needs to be treated immediately and more aggressively than chronic leukemia. Immediately after diagnosis, a first round of chemotherapy, called induction therapy, is given. The purpose of induction therapy is to destroy the leukemia cells and bring about remission. . Several combinations of standard chemotherapy agents are used, depending on the type of leukemia being treated. Once the individual is in remission, a second round of chemotherapy called consolidation therapy begins. Its purpose is to prolong remission and improve the chances of cure. Consolidation therapy is followed by maintenance chemotherapy. In acute lymphoblastic leukemia, intermittent maintenance therapy continues for at least 3 years. In acute myeloid leukemia, therapy typically continues for at least 1 year.

High-energy radiation therapy that damages cancer cells and stops them from growing is used in conjunction with chemotherapy for some kinds of leukemia. Radiation may be directed to one specific area of the body where there is a collection of leukemia cells, such as the spleen or testicles. In other individuals, radiation may be directed to the whole body (total-body radiation).

Bone marrow transplant (BMT) for individuals with acute leukemia may be performed after relapse or when efforts to achieve remission have failed. In acute lymphocytic leukemia, a bone marrow transplant may be done during the first complete remission. The ideal marrow donor is a matched sibling (allograft, or transplant from a different individual). Bone marrow transplant using marrow from a matched sibling may be done for individuals with acute myeloid leukemia who are younger than 40. If this is not an option, the marrow may come from a matched unrelated donor. After chemotherapy and radiation therapy have destroyed leukemia cells and new healthy bone marrow has been regenerated, individuals younger than age 55 who are in remission may have some of their restored bone marrow removed. The bone marrow can then be transplanted later in the course of their disease if needed (autologous BMT).

Biological therapy involves treatment with substances, such as interferon, that affect the response of the immune system to cancer. T-cell therapy, another immune-based treatment (cellular immunology), has been shown to have an antileukemic effect in individuals who have had hematopoietic stem cell transplant (HSCT) to replace leukemic cells with normally functioning cells. The goal of cellular immunology and T-cell treatment in particular is to develop a more effective standard therapy or vaccination for leukemia.

In chronic leukemia, because early treatment has not been shown to make a difference in the course of the disease, treatment is determined by symptoms and the presence of anemia, lymph involvement, and / or rapidly increasing white blood cell counts. As chronic lymphocytic leukemia advances, it is treated with a form of chemotherapy that has shown the best response and may induce longer remission. Standard therapy for chronic lymphocytic leukemia includes combined chemotherapy; individuals may be advised to participate in clinical trials of the most advanced chemotherapeutic agents; autologous and hematopoietic stem cell transplantation may be advised for patients whose disease progresses even while receiving appropriate therapeutic agents (Grever). In advanced cases, the spleen may be irradiated. Bone marrow transplant is typically not performed for chronic lymphocytic leukemia because it does not prolong survival.

Antibiotic therapies are administered when infections such as pneumonia result from immune system dysfunction in leukemia patients. Fungal infections are treated with antifungal medications.

Some individuals coping with the shock of undergoing treatment for a life-threatening illness may require psychological support.

Source: Medical Disability Advisor



Prognosis

The predicted outcome varies according to the type of leukemia. Cure is a realistic outcome for acute myeloid leukemia and acute lymphoblastic leukemia in young to middle-aged patients; the prognosis is worse in infants, the elderly, and individuals with concomitant kidney or liver disease, central nervous system involvement, or an exceedingly high WBC count (Freireich). Untreated acute leukemia has a poor prognosis: on average, individuals survive 3 to 6 months (Freireich). Adults with acute lymphoblastic leukemia have a 20% to 40% cure rate with current therapies (Seiter, "ALL"). Bone marrow transplant from a fully HLA-matched sibling donor produces disease-free survival in 20% to 40% of individuals with acute leukemia; this increases to 40% to 50% in younger patients who receive stem cell transplants (Freireich).

The average survival period for an individual with chronic lymphocytic leukemia diagnosed at an early stage is 10 years. If diagnosed at a late stage, the average survival period is 30 months (Grever).

Acute myeloid leukemia has a remission rate ranging from 50% to 80% for adults younger than 55; the cure rate following BMT using an HLA-matched sibling donor is 60%; the presence of certain chromosomal changes predicts a better prognosis, but having a prior hematologic disorder may predict a poor response to therapy (Seiter, "AML").

Individuals with chronic myeloid leukemia spend an average of 3 to 6 years in the chronic phase. When the disease finally progresses to an acute phase during which immature leukemic cells are seen in the peripheral blood (blast crisis), its course resembles that of acute leukemia.

Cure rates following BMT may be lower if the marrow transplant is the individual's own marrow (autologous BMT) or from a matched unrelated donor.

Source: Medical Disability Advisor



Differential Diagnosis

  • Aplastic anemia
  • Infectious mononucleosis
  • Infiltrative disease of the bone marrow
  • Lymphoma
  • Multiple myeloma
  • Myelodysplastic syndrome
  • Viral infection

Source: Medical Disability Advisor



Specialists

  • Hematologist
  • Oncologist
  • Pathologist
  • Radiology Oncologist

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications of leukemia can include bleeding, infection, anemia, involvement of the central nervous system or other body sites, and secondary cancers. Chemotherapy and radiation therapy cause nausea, vomiting, diarrhea, bone marrow suppression, and immunosuppression. Bone marrow transplant carries an additional risk of early death due to complications, including graft-versus-host disease.

Complications in chronic lymphocytic leukemia include severe immunodeficiency, autoimmune hemolysis, thrombocytopenia, increased risk of infection (particularly pulmonary infection), increased risk (20%) of secondary cancers, and progression to a high-grade lymphoid malignancy such as lymphoma (Grever).

Source: Medical Disability Advisor



Factors Influencing Duration

The length of disability is based on the type of leukemia; stage; type of treatment; individual's response to treatment; side effects of treatment; availability of a BMT donor; involvement of central nervous system and other body sites; development of infections and / or the development of secondary cancers; and individual's age, nutritional status, emotional or mental health, and overall health.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Individuals with acute leukemia are not able to work during their treatment. Individuals receiving outpatient chemotherapy or radiation therapy may require time off from work because of the side effects of the treatment. If they are able to work, individuals may require sedentary work due to fatigue. Individuals cannot work for 6 to 12 months after treatment with BMT.

Risk: According to "Work Ability and Return to Work," "Risk in cancer survivors may be due to chemotherapy. If there is physical exam or electrodiagnostic test evidence of chemotherapy associated peripheral neuropathy, balance may be impaired, and restrictions that would prevent climbing to heights may be indicated. If corticosteroids or chemotherapy have resulted in osteoporosis, restrictions to prevent pathologic fracture may be indicated (limited climbing to heights, limited heavy lifting, etc). As long as immune system suppression exists after treatment, patients should be restricted from working with sick animals or humans and from fungal exposure (e.g., gardening)." For more information, refer to "Work Ability and Return to Work," page 406.

Capacity: According to "Work Ability and Return to Work," "Patients may have residual myopathy after chemotherapy, and functional testing may be indicated to quantitate residual functional capacity. Some chemotherapy agents have cardiac and pulmonary toxicity, and treadmill testing of exercise ability may be helpful to establish current ability. Similarly, some cancer surgery (eg, pneumonectomy) will decrease cardiopulmonary function (capacity for work or exercise). Similarly, anemia may be significant during and after chemotherapy, and treadmill exercise testing can give both the physician and the patient an idea about exercise or work capacity." For more information, refer to Work Ability, pages 406-407.

Tolerance: According to "Work Ability and Return to Work," "Patients undergoing chemotherapy and / or radiation therapy typically have symptoms like nausea, diarrhea, and fatigue that are clearly due to their treatment, and in Western society these symptoms are traditionally judged to be severe enough to justify certification of work absence during the active phase of cancer treatment. Despite these symptoms, many of the self employed and uninsured return to work." Please refer to Chapter 21, Hematology/Oncology in “Work Ability,” page 407 for further information. Tolerance issues tend to predominate, especially after normal expected surgical healing. Chemotherapy can have effects on functioning which limits tolerance for the work environment. Ideally, reduced work hours may accommodate that limitation while creating a permissive environment of eventual return to work.

Source: Medical Disability Advisor



Maximum Medical Improvement

Patients undergoing chemotherapy are not at MMI until 90 days post-chemo. Patients who require surgery only would be at MMI at 90 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was the diagnosis confirmed?
  • What type of leukemia does individual have?
  • Does individual have underlying conditions such as diabetes, kidney or liver disease, or anemia that may affect treatment, therapy, or recovery?

Regarding treatment:

  • What type of leukemia does individual have?
  • Has individual received induction therapy, consolidation therapy, and maintenance chemotherapy for treatment of diagnosed acute leukemia?
  • Is individual in remission?
  • Is individual a candidate for a BMT? Stem cell transplant?
  • Does individual have an HLA-matched sibling donor?
  • Does individual's age preclude using his or her own marrow? Has an HLA-matched unrelated donor been located?
  • Has chemotherapy or spleen radiation been effective in reducing symptoms or increasing white blood cell counts for individuals with chronic leukemia?

Regarding prognosis:

  • What type of leukemia does individual have?
  • At what stage in the disease was it diagnosed?
  • Was remission effectively induced?
  • Did the individual have a prior (antecedent) hematologic disorder that is associated with a poor outcome to therapy?
  • Did individual receive a BMT? Stem cell transplant?
  • At what stage in the disease was the BMT performed?
  • Did individual develop complications from the disease, chemotherapy, or BMT?
  • How are complications being managed?
  • Has individual relapsed after a significant period of remission?
  • Is individual's nutritional status being monitored? Is individual prone to infections due to a low white blood cell count? What precautions is individual using against infection?

Source: Medical Disability Advisor



References

Cited

"Facts 2012." Leukemia and Lymphoma Society. Leukemia and Lymphoma Society. 11 Mar. 2013 <http://www.lls.org/content/nationalcontent/resourcecenter/freeeducationmaterials/generalcancer/pdf/facts.pdf>.

Freireich, Emil J. "Acute Leukemia." The Merck Manual of Diagnosis and Therapy. Eds. Robert S. Porter, et al. 18th ed. Whitehouse Station, NJ: Merck and Company, Inc., 2008. Merck. Jul. 2012. Merck & Co., Inc. 11 Mar. 2012 <http://www.merck.com/mmpe/sec11/ch142/ch142b.html>.

Grever, Michael R., Leslie A. Andrisos, and Gerard Lozanski. "Chronic Lymphoid Leukemias." Clinical Oncology. Eds. Martin D. Abeloff, et al. 4th ed. Churchill Livingstone Elsevier, 2008. MD Consult. Elsevier, Inc. 7 Aug. 2009 <www.mdconsult.com>.

Seiter, Karen. "Acute Lymphoblastic Leukemia." eMedicine. Eds. Emmanuel C. Besa, et al. 16 Jan. 2013. Medscape. 11 Mar. 2013 <http://emedicine.medscape.com/article/207631-overview>.

Seiter, Karen. "Acute Myelogenous Leukemia." eMedicine. Eds. Emmanuel C. Besa, et al. 9 Mar. 2012. Medscape. 11 Mar. 2013 <http://emedicine.medscape.com/article/197802-overview>.

Swerdlow, S. H. , et al., eds. World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues. International Agency for Research on Cancer, 2008.

Talmage, J. B. , J. M. Melhorn, and M. H. Hyman, eds. Work Ability and Return to Work, AMA Guides to the Evaluation of. Second ed. Chicago: AMA Press, 2011.

Source: Medical Disability Advisor