Stem Cell Transplantation: Solid Tumors - (0534)

Cigna covers autologous HSCT for select pediatric/young‑adult solid tumors (supratentorial PNET, medulloblastoma), relapsed/progressive Ewing, relapsed/refractory germ cell tumors (testicular/ovarian — with up to three autologous HSCTs as second‑line for metastatic germ cell disease and single/tandem use for relapsed/refractory cases), high‑risk neuroblastoma (autologous; allogeneic only if not a candidate for autologous, with up to three tandem autologous HSCTs allowed), retinoblastoma and relapsed Wilms, while HSCT is considered not medically necessary for many adult solid tumors, most CNS tumors (e.g., glioblastoma, anaplastic glioma, ependymoma), and front‑line or allogeneic HSCT for testicular cancer. Key requirements: allogeneic donors must be appropriately HLA‑matched; documented diagnosis, prior treatments, HLA/donor suitability, organ function and performance status are required (contraindications/relative contraindications include EF <35%, bilirubin >2 mg/dL or transaminases >2× normal, CrCl <50 mL/min, DLCO <50% predicted, uncontrolled HIV, active hepatitis B/C or HTLV‑1, Karnofsky <60%/ECOG >2), and coverage is subject to the member’s benefit plan and proper billing/coding.