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Hematopoietic Cell Transplantation for Waldenstrom Macroglobulinemia

Section: Surgery
Effective Date: July 01, 2018
Revised Date: November 14, 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 patients who receive bone-marrow-toxic doses of cytotoxic drugs with or without whole body radiotherapy. Hematopoietic cells may be obtained from the transplant recipient (autologous HCT) or from a donor (allogeneic HCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood shortly after delivery of neonates. Although cord blood is an allogeneic source, the cells in it are antigenically “naive” and are associated with a lower incidence of rejection or graft-versus-host disease (GVHD).

Criteria

Autologous HCT may be considered medically necessary as salvage therapy of chemosensitive Waldenström macroglobulinemia.

Procedure Codes

38206 38220 38221 38222 38232 38241

Allogeneic HCT is considered experimental/investigational, and therefore, non-covered to treat Waldenström macroglobulinemia. Available scientific evidence does not permit conclusions concerning this intervention on health outcomes.

 

Procedure Codes

38205 38220 38221 38222 38230 38240 S2140
S2142

Diagnosis Codes

C88.0

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