Agent Orange and Chronic Lymphocytic Leukemia

What is chronic lymphocytic leukemia?

Chronic lymphocytic leukemia (CLL) is the most common of the four primary forms of leukemia: the acute and chronic forms of lymphocytic leukemia and acute and chronic forms of myeloid leukemia. It is most common in men.

Why are Vietnam veterans concerned about chronic lymphocytic leukemia?

Some Vietnam veterans have been diagnosed with chronic lymphocytic leukemia and others have expressed concern about developing this illness. Some research has suggested that chronic lymphocytic leukemia may be associated to exposure with herbicides, but there is no conclusive evidence that Agent Orange or other herbicides used in Vietnam cause this condition. About 31,000 Americans are diagnosed with leukemia annually and about 22,000 die from it. In 2002, leukemias account for about 2.5% of new cancer cases and about 4% of cancer deaths.

What happens to veterans with CLL?

CLL is a disease that progresses slowly with increasing production of excessive numbers of white blood cells. The chance of recovery largely depends on the stage the disease is diagnosed and the veteran’s health. Treatment plans depend on these factors.

What did the National Academy of Sciences (NAS) conclude about chronic lymphocytic leukemia in its 2002 report, Veterans and Agent Orange: Update 2002?

The report stated, “A reanalysis of. . studies indicates that. . . exposure to herbicides is associated with significant risk of CLL mortality.” The NAS concluded that there is “sufficient” evidence of an association between exposure to herbicides and CLL.

The NAS places illnesses in the first category when a positive association has been observed between herbicides and the outcomes in studies where chance, bias, and confounding could be ruled out with confidence. CLL’s inclusion in this category is the first time a condition has been added to this category since the initial report was issued.
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The initial NAS report, Veterans and Agent Orange: Health Effects of Herbicides Used in Vietnam, dated 1994, and subsequent report updates, dated 1996, 1998 and 2000, had considered all forms of leukemia together. The NAS focused on CLL in Update 2002 at the request of VA because of veterans’ concerns that CLL shared similarities with non-Hodgkin’s lymphoma, a condition that has been recognized with service connection for several years.

What did the Department of Veterans Affairs do in response to the NAS findings?

After carefully reviewing the NAS report, VA’s Secretary Principi determined that there is an association between exposure to herbicides used in Vietnam and the subsequent development of CLL. The proposed rule was published for public comment in the Federal Register in March 2003. (See 68 Fed. Reg. 14567, March 26, 2003). The final rule implementing the determination was published in the Federal Register in October 2003. (See 68 Fed. Reg. 59540, October 16, 2003).

Where can a veteran obtain additional information on this subject?

Information on CLL and related matters can be obtained at VA medical center libraries, from the Environmental Health Clinicians at every VA medical center, or from the Environmental Agents Service (131), Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420.

Where can a veteran obtain additional information regarding Agent Orange-related issues?

The following Agent Orange Brief fact sheets (including the one you are reading) are available on the World Wide Web at www.va.gov/AgentOrange: A1.Agent Orange - General Information; A2.Agent Orange Class Action Lawsuit; B1.Agent Orange Registry Program; B2.Agent Orange – Health Care Eligibility; B3.Agent Orange and VA Disability Compensation; B4.VA Information Resources on Agent Orange and Related Matters; C1.Agent Orange – The Problem Encountered in Research; C2.Agent Orange and Vietnam Related Research – VA Projects; C3.Agent Orange and Vietnam Related Research – Non-VA Projects; D1.Agent Orange and Birth Defects; D2.Agent Orange and Chloracne; D3.Agent Orange and Non-Hodgkin’s Lymphoma; D4.Agent Orange and Soft Tissue Sarcomas; D5.Agent Orange and Peripheral Neuropathy; D6.Agent Orange and Hodgkin’s Disease; D7.Agent Orange and Porphyria Cutanea Tarda; D8.Agent Orange and Multiple Myeloma; D9.Agent Orange and Respiratory Cancers; D10.Agent Orange and Prostate Cancer; D11.Agent Orange and Spina Bifida; D12.Agent Orange and Diabetes; and D13.Agent Orange and Chronic Lymphocytic Leukemia. Hard copies can be obtained from local VA medical centers or from the VA Central Office at the Environmental Agents Service (131) Department of Veterans Affairs, 810 Vermont Avenue, N.W., Washington, DC 20420. At the same Web site you will find copies of past and current issues of the “Agent Orange Review” newsletter and other items of interest.

This fact sheet was prepared in late October 2003 and does not include subsequent developments.