Hematopoietic stem-cell transplantation (HSCT) refers to a procedure in which hematopoietic stem 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. Hematopoietic stem cells may be obtained from the transplant recipient (autologous HSCT) or from a donor (allogeneic HSCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates.
A single or second (salvage) autologous HSCT may be considered medically necessary to treat multiple myeloma.
Tandem autologous HSCT may be considered medically necessary to treat multiple myeloma in patients who fail to achieve at least a near-complete or very good partial response after the first transplant in the tandem sequence. A near complete response, as defined by the European Group for Blood and Marrow Transplant (EBMT), is the disappearance of M protein at routine electrophoresis, but positive immunofixation. A very good partial response has been defined as a 90% decrease in the serum paraprotein level.
Tandem transplantation with an initial round of autologous HSCT followed by a non-marrow-ablative conditioning regimen and allogeneic HSCT (i.e., reduced-intensity conditioning transplant) may be considered medically necessary to treat newly diagnosed multiple myeloma patients.
Autologous HSCT for the treatment of multiple myeloma that does not meet the above criteria is considered not medically necessary.
Allogeneic hematopoietic stem-cell transplantation, myeloablative or nonmyeloablative, as upfront therapy of newly diagnosed multiple myeloma or as salvage therapy, is considered experimental/investigational and therefore non-covered as the safety and efficacy of this service cannot be established by the available published peer review literature.
Autologous HSCT may be considered medically necessary to treat disseminated Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin abnormalities (POEMS) syndrome.
Allogeneic and tandem HSCT is considered experimental/investigational to treat POEMS syndrome syndrome and therefore non-covered because the safety and/or efficacy of this service cannot be established by the available published peer review literature.
Applies to Autologous Hematopoietic Stem-cell Transplants
Applies to POEMS Syndrome
Non-Covered Diagnosis Codes
Applies to Allogeneic Hematopoietic Stem-cell Transplants
Applies to POEMS Syndrome