Chronic Lymphocytic Leukemia - SI

[My Flight Surgeon]

This is another in the series of condition for which the FAA grants Special Issuance certificates.

As with all other conditions, the FAA will want to review the entire medical record. Your AME or http://www.faaspecialissuance.com can assist you in preparing your records for submission.

The following is information regarding Chronic Lymphocytic Leukemia (CLL).

Chronic lymphocytic leukemia (CLL) is a type of cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made. It's called chronic leukemia because it progresses more slowly than acute leukemia. It's called lymphocytic leukemia because it affects a group of white blood cells called lymphocytes, which typically fight infection. Each year, about 10,000 people in the United States receive a diagnosis of chronic lymphocytic leukemia.
Signs and symptoms
At first, chronic lymphocytic leukemia may cause no signs or symptoms. When signs and symptoms are present in the early phases of the disease, they are often vague and unspecific and include:

• Fever
• Weight loss
• Loss of appetite
• Lethargy and fatigue, especially during exercise
• Night sweats

More specific signs and symptoms may emerge in the more advanced phases of untreated chronic leukemia. These signs and symptoms occur when leukemic cells crowd out properly functioning, mature blood cells. A range of problems can occur, depending on the type of blood cell affected:

• Red blood cells. These cells carry oxygen from your lungs to all parts of your body. A shortage of red blood cells (anemia) can cause shortness of breath, fatigue, pale skin and other problems.
• White blood cells. These infection fighters help your body ward off germs. A shortage of healthy white blood cells (leukopenia) or of a particular type of healthy white blood cells called neutrophils (neutropenia or granulocytopenia) can result in frequent infections. People with chronic lymphocytic leukemia are actually more likely to have very high white blood cell counts, but the white blood cells aren't functioning properly, so they don't protect against infection the way normal white blood cells do.
• Blood platelets. These cells help prevent and control bleeding by prompting your blood to clot. A shortage of blood platelets (thrombocytopenia) can result in easy bleeding and bruising, including frequent or severe nosebleeds, bleeding from the gums, or tiny red marks caused by bleeding into the skin (petechiae).

Chronic lymphocytic leukemia can also cause bone pain, joint pain, swelling of the liver and spleen, and enlargement of the lymph nodes in the neck, underarm, stomach or groin.
Risk factors

Unlike other forms or cancer or leukemia, chronic lymphocytic leukemia has few known risk factors. Some studies have suggested that exposure to herbicides and insecticides, such as those used in farming or those used in Agent Orange during the Vietnam War, may increase the risk of chronic lymphocytic leukemia.
In general, this type of leukemia tends to affect older adults. Most cases of chronic lymphocytic leukemia are found in people age 50 and older, and incidence increases with age.
FAA Special Issuance
An FAA physician provides the initial certification decision and grants the Authorization in accordance with 14CFR67.401. The Authorization letter is accompanied by attachments that specify the information that treating physician(s) must provide for the re-issuance determination. If this is a first time issuance of an Authorization for the above disease/condition, and the applicant has all of the requisite medical information necessary for a determination, the Examiner must defer and submit all of the documentation to the AMCD or the Regional Flight Surgeon for the initial determination.

Examiners may re-issue an airman medical certificate under the provisions of an Authorization, if the applicant provides the following:

• An Authorization granted by the FAA;
• A clinical followup report from the treating physician that includes an update of the condition of the applicant since the last examination; and
• The results of any applicable laboratory results, including a complete blood count performed within last 90 days.

The Examiner must defer to the AMCD or Region if:

• The condition currently requires treatment with a chemotherapeutic agent; or
• The white blood cell count has risen above 80,000.