Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma

Section: Surgery
Effective Date: July 01, 2018
Revised Date: November 25, 2019
Last Reviewed: November 14, 2019

Description

Hematopoietic cell transplantation (HCT) refers to a procedure in which hematopoietic cells are infused to restore bone marrow function in cancer individuals who receive bone-marrow-toxic doses of cytotoxic drugs with or without whole-body radiation therapy. Hematopoietic cells may be obtained from the transplant recipient (autologous HCT) or from a donor (allogeneic HCT) and can be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates.

Criteria

Allogeneic HCT may be considered medically necessary to treat:

  • Chronic lymphocytic leukemia; or
  • Small cell lymphocytic leukemia in patients with markers of poor-risk disease.

Use of a myeloablative or reduced-intensity pre-transplant conditioning regimen should be individualized based on factors that include individuals age, the presence of comorbidities, and disease burden.

Autologous HCT is considered experimental/investigational, and therefore, non-covered to treat chronic lymphocytic leukemia or small lymphocytic lymphoma. Available scientific evidence does not permit conclusions concerning the effect of autologous HCT on health outcomes for chronic lymphocytic leukemia or small lymphocytic lymphoma.

Procedure Codes

38205 38206 38220 38221 38222 38240 38241
S2140 S2142

Diagnosis Codes

C91.10 C91.11

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