Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin's and Non-Hodgkin's Lymphoma with B-cell or T-cell Origin
L39477
This policy locally covers allogeneic HSCT for primary refractory or relapsed Hodgkin and non-Hodgkin lymphomas of B- or T-cell origin when no other curative-intent options exist, and reiterates CMS NCD 110.23 national coverage for selected conditions (e.g., leukemia, aplastic anemia, SCID, Wiskott-Aldrich, MDS). Certain conditions (multiple myeloma, myelofibrosis, severe sickle cell disease) are eligible only under CMS Coverage with Evidence Development (CED) within approved prospective studies. Documentation must demonstrate disease refractory/relapsed status, clinical fitness (age, performance, organ function), infection screening, psychosocial/financial support, and consideration or use of formal transplant risk scores (EBMT or HCT-CI).
"Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is covered for primary refractory Hodgkin lymphoma when there are no other curative-intent treatment options."