Stem Cell Transplantation: Blood Cancers - (0533)

Cigna covers disease‑specific allogeneic and/or autologous hematopoietic stem‑cell transplantation for many blood cancers (e.g., ALL, AML, CML, MDS, myelofibrosis, MM, Hodgkin/NHL, amyloidosis, POEMS, CMML/JMML, PCNSL, systemic mastocytosis) per the listed criteria, while specified uses (e.g., autologous HSCT for CML, tandem HSCT in many settings, some second autologous transplants, stage I NHL, and other disease‑specific items) are considered experimental, investigational, or not medically necessary. Key requirements include an appropriately matched HLA donor for allogeneic transplants, documentation of diagnosis/remission/relapse and prior therapies, disease‑risk stratification, and pre‑transplant suitability with organ/function thresholds (e.g., EF ≥35%, bilirubin ≤2.0 mg/dL, CrCl ≥50 mL/min, DLCO ≥50%, acceptable performance status) and infectious disease control.

"All allogeneic transplantations must be from an appropriately matched human leukocyte antigen (HLA) donor."