Nonmyeloablative Allogeneic Stem Cell Transplants

This policy covers reduced‑intensity conditioning (RIC) or nonmyeloablative regimens as nonfully ablative conditioning for allogeneic hematopoietic stem cell transplantation for selected hematologic conditions and marrow/metabolic disorders (examples include AML, ALL, myelodysplastic syndromes, relapsed/refractory non‑Hodgkin lymphomas such as follicular and mantle cell, inherited bone marrow failure syndromes, and certain lysosomal storage disorders). Coverage requires careful clinical selection with variable definitions of RIC/nonmyeloablative regimens, excludes some indications (e.g., sickle cell/β‑thalassemia handled under CP.MP.108 and tandem myeloma transplants under CP.MP.162), and is limited by physiologic contraindications such as bilirubin >2 mg/dL, INR >1.6 (unless due to anticoagulation), LVEF <45%, FEV1 ≤50% or DLCO ≤60% predicted, poor performance status (Karnofsky/Lansky <70 or ECOG >2), advanced age, significant comorbidities, and higher relapse risk after HCT.