Acute myeloid leukaemia — DVA SoP factors

Reasonable Hypothesis (RH) — Statement of Principles No. 21 of 2024

At least one of the following factors must as a minimum exist before it can be said that a reasonable hypothesis has been raised connecting acute myeloid leukaemia or death from acute myeloid leukaemia with the circumstances of a person's relevant service:

1. (1)
   having smoked tobacco products: (a) in an amount of at least 10 pack-years before clinical onset; and (b) commencing at least 5 years before clinical onset; and (c) if smoking has ceased before clinical onset, then that onset occurred within 15 years of cessation;

   Note: one pack-year is defined in the Schedule 1 - Dictionary.

2. (2)
   having one of the following haematological disorders at the time of clinical onset: (a) myelodysplastic syndrome; (b) myelodysplastic/myeloproliferative neoplasm; (c) aplastic anaemia; or (d) paroxysmal nocturnal haemoglobinuria;

   Note: myelodysplastic / myeloproliferative neoplasm is defined in the Schedule 1 - Dictionary.

   Note: myelodysplastic syndrome is also known as myelodysplastic neoplasm.

3. (3)
   having one of the following myeloproliferative neoplasms at the time of the clinical onset of acute myeloid leukaemia: (a) chronic myeloid leukaemia; (b) essential thrombocythaemia; (c) polycythaemia vera; (d) primary myelofibrosis; (e) chronic eosinophilic leukaemia; (f) chronic neutrophilic leukaemia; (g) juvenile myelomonocytic leukaemia; or (h) myeloproliferative neoplasm, not otherwise specified;
4. (4)
   undergoing a course of treatment with one of the following drugs at least 6 months before clinical onset and if treatment has ceased before clinical onset, then that onset occurred within 20 years of cessation: (a) alkylating agent; (b) topoisomerase II inhibitor; (c) azathioprine; (d) platinum agents; or (e) poly(ADP-ribose) polymerase inhibitors (PARP inhibitors);

   Note: Examples of topoisomerase II inhibitors include etoposide, teniposide, mitozantrone (also known as mitoxantrone), daunorubicin, doxorubicin, epirubicin, and idarubicin. Examples of platinum agents include carboplatin, cisplatin, and oxaliplatin. Examples of PARP inhibitors include olaparib, rucaparib, niraparib, talazoparib and veliparib.

5. (5)
   having received a cumulative equivalent dose of at least 0.01 sievert of ionising radiation to the bone marrow at least one year before the clinical onset;

   Note: cumulative equivalent dose is defined in the Schedule 1 - Dictionary.

6. (6)
   undergoing ablative treatment with radioactive iodine for cancer before clinical onset, where the first exposure occurred at least one year before clinical onset;
7. (7)
   undergoing ablative treatment with radioactive phosphorus for a myeloproliferative neoplasm before clinical onset, where the first exposure occurred at least one year before clinical onset;
8. (8)
   being exposed to benzene as specified: (a) for a cumulative total of at least 1,250 hours within a continuous period of 5 years before clinical onset; and (b) where the first exposure in that period occurred at least 2 years before clinical onset;

   Note: being exposed to benzene as specified is defined in the Schedule 1 - Dictionary.

9. (9)
   inhaling, ingesting or having cutaneous contact with benzene: (a) in an amount greater than 5 ppm-years of cumulative exposure before clinical onset; and (b) where the first exposure occurred at least 2 years before clinical onset;

   Note: ppm-years is defined in the Schedule 1 - Dictionary.

10. (10)
    being obese for at least 5 years within the 20 years before clinical onset;

    Note: being obese is defined in the Schedule 1 - Dictionary.

11. (11)
    undergoing organ or haematopoietic stem cell transplantation, excluding corneal transplant, before the clinical onset;
12. (12)
    having infection with human immunodeficiency virus before clinical onset;
13. (13)
    inhaling formaldehyde: (a) for a cumulative total of at least 5,000 hours within a continuous period of 10 years before the clinical onset of acute myeloid leukaemia; and (b) where the first exposure in that period occurred at least 5 years before the clinical onset of acute myeloid leukaemia;

    Note: inhaling formaldehyde is defined in the Schedule 1 - Dictionary.

14. (14)
    having one of the following autoimmune diseases before clinical onset: (a) autoimmune haemolytic anaemia; (b) giant cell arteritis; (c) pernicious anaemia; (d) polymyalgia rheumatica; (e) rheumatoid arthritis; (f) sarcoidosis; (g) systemic lupus erythematosus; (h) systemic vasculitis; or (i) ulcerative colitis;
15. (15)
    inhaling, ingesting or having cutaneous contact with one of the following pesticides for a cumulative period of at least 1,000 hours before the clinical onset of acute myeloid leukaemia, where the first exposure occurred at least 5 years before clinical onset: (a) aldrin; (b) dieldrin; (c) diazinon; (d) chlordane; or (e) heptachlor;
16. (16)
    inhaling styrene: (a) for a cumulative total of at least 2,500 hours within a continuous period of 5 years before the clinical onset of acute myeloid leukaemia; and (b) where the first exposure in that period occurred at least 5 years before the clinical onset of acute myeloid leukaemia;

    Note: Inhalation of styrene can occur in the manufacture of fibreglass-reinforced plastic products, in the production of styrene, polystyrene, and styrene-based plastics and rubbers, and in the use of products containing styrene, such as paints, adhesives, metal cleaners, and varnishes.

    Note: inhaling styrene is defined in the Schedule 1 - Dictionary.

17. (17)
    being exposed to styrene: (a) in an amount greater than 10 ppm-years of cumulative exposure before the clinical onset of acute myeloid leukaemia; and (b) where the first exposure occurred at least 5 years before the clinical onset of acute myeloid leukaemia;

    Note: ppm-years is defined in the Schedule 1 - Dictionary.

18. (18)
    inability to obtain appropriate clinical management for acute myeloid leukaemia before clinical worsening;

Aggravation-only factors: the factors in subsection 9(18) apply only to material contribution to, or aggravation of, the condition where it was suffered or contracted before or during (but did not arise out of) the person’s relevant service.