Allogeneic Hematopoietic Cell Transplantation
Allogeneic hematopoietic cell transplantation (allo-HCT) involves the intravenous (IV) infusion of allogeneic (donor) stem cells to reestablish hematopoietic function in individuals whose bone marrow or immune system is damaged or defective. They can be harvested from bone marrow, peripheral blood, or umbilical cord blood and placenta shortly after delivery of neonates.
Myeloablative allo-HCT may be considered medically necessary as a treatment of:
Reduced-intensity conditioning allo-HCT may be considered medically necessary in individuals, who for medical reasons would be unable to tolerate a myeloablative conditioning regimen as a treatment of:
Myeloablative allo-HCT or reduced-intensity conditioning allo-HCT for myelodysplastic syndromes and myeloproliferative neoplasms that do not meet the criteria of this policy is considered experimental/investigational (E/I) and therefore non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
National Comprehensive Cancer Network (NCCN)-2019
Current National Comprehensive Cancer Networkclinical guidelines for myelodysplastic syndromes (v.1.2020)make the following general recommendation about allo-HCT:
“For individuals who are transplant candidates, an HLA [human leukocyte antigen]-matched sibling, or HLA-matched unrelated donor can be considered. Results with HLA-matched unrelated donors have improved to levels comparable to those obtained with HLA-matched siblings. With the increasing use of cord blood or HLA-haploidentical related donors, HCT has become a viable option for many individuals. High-dose conditioning is typically used for younger individuals, whereas RIC [reduced-intensity conditioning] for HCT is generally the strategy in older individuals.”
American Society for Blood and Marrow Transplantation-2015
The American Society for Blood and Marrow Transplantation (2015) categorized the Indications for HCT into five areas as follows:
The ASBMT will periodically review these guidelines and will update them as new evidence becomes available.