Hematopoietic Cell Transplantation
Hematopoietic cell transplantation (HCT) refers to a procedure in which hematopoietic cells are infused to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of cytotoxic drugs with or without whole body radiation therapy.
Conventional Preparative Conditioning for HCT
The conventional (classical) practice of allogeneic HCT involves administration of cytotoxic agents (e.g., cyclophosphamide, busulfan) with or without total body irradiation at doses sufficient to destroy endogenous hematopoietic capability in the recipient. The beneficial treatment effect in this procedure is due to a combination of initial eradication of malignant cells and subsequent graft-versus-malignancy (GVM) effect that develops after engraftment of allogeneic cells within the patient’s bone marrow space.
Reduced-Intensity Conditioning for Allogeneic HCT
Reduced-intensity conditioning (RIC) refers to the pretransplant use of lower doses or less intense regimens of cytotoxic drugs or radiation than are used in conventional full-dose myeloablative conditioning treatments.
Allogeneic HCT using a myeloablative conditioning regimen may be considered medically necessary as a treatment of chronic myeloid leukemia (CML).
Allogeneic HCT using a RIC regimen may be considered medically necessary as a treatment of chronic myeloid leukemia in individuals who meet clinical criteria for an allogeneic HCT but who are not considered candidates for a myeloablative conditioning allogeneic HCT. These include those individuals whose age (typically greater than 60 years) or comorbidities (e.g., liver or kidney dysfunction, generalized debilitation, prior intensive chemotherapy, low Karnofsky Performance Status) preclude use of a standard myeloablative conditioning regimen.
Autologous cell transplantation is considered experimental/investigational and, therefore, non-covered as a treatment of CML.
Although it remains a research interest, improved outcomes have not been demonstrated for autologous HCT compared with conventional chemotherapy in individuals with CML. At this time the role of autologous HCT for this indication has not been established.
Autologous blood-derived hematopoietic progenitor cell harvesting and autologous bone marrow harvesting are considered experimental/investigational and, therefore, non-covered for autologous transplantation as a treatment of CML because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature.
Covered Diagnosis Codes for Procedure Codes 38204, 38205, 38208, 38209, 38210, 38211, 38212, 38213, 38214, 38215, 38220, 38221, 38222, 38230, 38240, S2140 and S2142
Non-covered Diagnosis Codes for Procedure codes 38206, 38232, and 38241