Stem Cell Transplantation: Blood Cancers - (0533)

Cigna covers disease‑specific autologous and/or allogeneic hematopoietic stem cell transplantation for many hematologic malignancies and related disorders (e.g., ALL, AML, MM, NHL, MDS, CML/CMML, JMML, amyloidosis, POEMS, primary CNS lymphoma, systemic mastocytosis) per listed indications and considers numerous uses experimental/not medically necessary (examples: autologous HCT for CML/CMML, tandem HSCT in many settings). Coverage requires an appropriately HLA‑matched donor for allogeneic transplants and documentation that disease‑specific criteria are met (remission/failure status, ELN/IPSS‑R risk stratification, MRD when applicable), prior therapy history, adequate organ function/performance status, and proper billing codes; significant comorbidities or poor organ function are contraindications.

"Allogeneic hematopoietic stem-cell transplantation (HSCT) is considered medically necessary for the treatment of acute lymphoblastic leukemia (ALL) when ANY of the following criteria are met: - fai..."