Each year nearly 27,000 adults learn they have leukemia.

Approximately 21,500 deaths of adults in the United States were attributed to leukemia in 2001 (12,100 males and 9,500 females).

• Leukemia is the most common cause of cancer death among men under age 40.
• Among women, leukemia is the leading cause of cancer death before age 20.
• The number of deaths attributed to leukemia in the United States is approximately 25 percent higher for males than females.

Leukemia can be grouped two ways:

1. How rapidly the disease develops and progresses.
2. The type of blood cell that is affected

Leukemia is classified as either acute or chronic.

In acute leukemia the abnormal blood cells are "blasts" (new or immature blood cells) that remain very immature and cannot carry out their normal function. The number of blasts increases rapidly, and the disease gets worse quickly.

In chronic leukemia, blasts are also affected, but they are able to mature to a degree and carry out some of their normal functions. Unlike acute leukemia, the number of blasts increases less rapidly. Chronic leukemia gets worse gradually.

Leukemia can arise from two main types of white blood cells:

Lymphoid
Myeloid

When leukemia affects lymphoid cells, it is called lymphocytic leukemia.

When leukemia affects myeloid cells, it is called myelogenous leukemia.

The four most common types of leukemia are:

Acute lymphocytic leukemia (ALL) This is the most common type of leukemia in children (95%). This disease is found in adults who are 65 and older.

Acute myeloid leukemia (AML) This occurs in both adults and children.

Chronic lymphocytic leukemia (CLL) While this occurs primarily in adults over the age of 55, it can affect younger adults.

Chronic myeloid leukemia (CML) This occurs mainly in adults.

Some of the common symptoms of leukemia include:

• Fever, chills
  
• Weakness and fatigue
  
• Frequent infections
  
• Loss of appetite and weight
  
• Swollen lymph nodes
  
• Swollen liver or spleen
  
• Easy bleeding
  
• Easy bruising
  
• Tiny red spots under the skin
  
• Swollen or bleeding gums
  
• Night sweats
  
• Bone or joint pain

The medical history, physical examination and blood tests help confirm the diagnosis. Blood tests help determine the number of mature cells and blasts. The patient will also undergo a bone marrow aspiration to determine if the leukemia involves the bone marrow.

Treatment for leukemia is complex and needs to be tailored for each person. Factors that influence the type of treatment include:

• Type of leukemia
  
• Leukemia cell features
  
• Extent of disease
  
• Prior treatments
  
• Age
  
• Symptoms
  
• General Health

Acute leukemia requires immediate treatment with the goal of bringing about remission. Remission is where there is no evidence of the disease. Once remission is achieved, additional treatment is given to prevent a relapse.

Many patients with acute leukemia can be cured.

Chronic leukemia patients who do not have any symptoms do not require immediate treatment. If treatment is eventually needed, it is targeted at controlling the disease and the symptoms.

Chronic leukemia is rarely cured.

Most patients with leukemia are treated with chemotherapy. Additional treatments include:

• Radiation therapy
  
• Bone marrow transplantation
  
• Biological therapy (i.e. interferon)
  
• Removal of spleen (called splenectomy)

Biological therapy is being studied in various clinical trials. New forms of biological therapy being studied include:

• Interleukins
  
• Colony-stimulating factors
  
• Monoclonal antibodies

Biological therapy is often combined with chemotherapy or bone marrow transplantation.

Underwriting Comments

Adult leukemia is not an easy medical problem to underwrite and many applicants are uninsurable for individual coverage. In most cases the applicant will need five (5) years of complete remission to be considered insurable. If the applicant requires a bone marrow transplant, the "postpone" period is generally longer.

The one exception to these guidelines is chronic lymphocytic leukemia (CLL). Applicants with CLL, who are over age 50 and stage 0 to stage 1, may be immediately insurable at a moderate rating (i.e. Table 3 to Table 4).

Below are the key screening questions for clients with a history of adult leukemia:

1. When was the leukemia diagnosed?
2. What is the "type" (i.e. A.L.L., C.L.L., etc.)?
3. How was the leukemia treated?
4. When did the treatment end?
5. Have there been any relapses (if yes, when)?
6. What medications is the applicant currently taking?
7. Any additional medical problems?

© Copyright 2002, RiskTutor Inc.