Fitness for commercial flying in a case of non-Hodgkin lymphoma: Aeromedical risk assessment

Non-Hodgkin lymphoma (NHL) comprises a category of malignant neoplasms that arise from lymphoid tissues, which primarily affect the lymph nodes. Histologically, diffuse large B-cell lymphoma (DLBCL) is the most common subtype of NHL. The various clinical manifestations depend on the site, stage, and extent of disease and are generally treated with Chemo-immunotherapy. A 39-year-old civil aircrew, diagnosed as a case of DLBCL, treated with chemo-immunotherapy (rituximab, cyclophosphamide, hydroxydaunorubicin, oncovin, and prednisolone regimen), after complete remission and drug-free status for 25-month duration, reported to an Indian Air Force boarding center for aeromedical evaluation and disposal. The survival rate post-treatment for DLBCL is 94% as per the International Prognostic Index. However, in the first 1–2 years, the recurrence rate is between 30 and 40%. Aeromedical concerns include treatment efficacy, recurrence/relapse, post-chemotherapeutic effects, aviation risk on disability, prognosis and follow-up duration, and investigations to be carried out. The risk assessment matrix was carried out in this case using 5-year prognosis survival, and the risk of incapacitation fell between 0.1% and 1%. The fitness for flying was considered on the basis of the incapacitation risk of <1% and upgraded to the restricted flying category. The certification assessment for malignancy can be based on the survival rate post-treatment due to the lack of evidence on the risk of recurrence. Hence, the certification for aircrew with any malignancy can be assessed by treatment efficacy, risk of recurrence, and risk of incapacitation. The survival curve can be used as a tool for calculating the risk of recurrence matrix and risk of incapacitation.