Hematopoietic Cell Transplantation
Hematopoietic cell transplantation (HCT) refers to the infusion of hematopoietic stem cells to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of cytotoxic drugs with or without whole body radiation therapy. Hematopoietic stem cells may be obtained from the transplant recipient (autologous HCT) or from a donor (allogeneic HCT).
Primary Systemic or AL amyloidosis is the most common type of amyloidosis. The clinical features are dependent on the organs involved, typically cardiac, renal, hepatic, peripheral, and autonomic neuropathy and soft tissue.
Autologous HCT may be considered medically necessary to treat AL amyloidosis (primary systemic amyloidosis) when ALL of the following patient selection criteria are met:
Note: When available, a clinical trial should be utilized.
Allogeneic HCT is considered experimental/investigational and therefore non-covered to treat AL amyloidosis (primary systemic amyloidosis). Available scientific evidence does not permit conclusions concerning this intervention on health outcomes.
Covered Diagnosis Codes Applies to Autologous Hematopoietic Cell Transplants
Non-Covered Diagnosis Codes Applies to Allogeneic Hematopoietic Cell Transplants
National Comprehensive Cancer Network (NCCN). NCCN Guidelines Version 1. 2018, Systemic Light Chain Amyloidosis.
The current NCCN Guidelines list the following as therapeutic considerations for management of patients with systemic light chain amyloidosis (all category 2A recommendation) along with best supportive care: high-does melphalan followed by autologous SCT; oral melphalan and dexamethasone; dexamethasone in combination with alpha-interferon; thalidomide plus dexamethasone; lenalidomide and dexamethasone; Lenalidomide/cyclophosphamide/dexamethasone; pomalidomide and dexamethasone; bortezomib with or without dexamethasone; bortezomib with melphalan plus dexamethasone; cyclophosphamide, thalomide, and dexamethasone; bortezomib, and dexamethasone.