Tandem autologous HCT may be considered medically necessary to treat multiple myeloma in individuals 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 HCT followed by a non-marrow-ablative conditioning regimen and allogeneic HCT (i.e., reduced-intensity conditioning transplant) may be considered medically necessary to treat newly diagnosed multiple myeloma individuals.
Autologous HCT for the treatment of multiple myeloma that does not meet the above criteria is considered not medically necessary.