Allogeneic Hematopoietic Cell Transplantation for Primary Refractory or Relapsed Hodgkin and Non-Hodgkin Lymphoma with B-cell or T-cell Origin
L39513
This policy locally covers allogeneic hematopoietic stem cell transplantation for patients with primary refractory or relapsed Hodgkin lymphoma and B-cell or T-cell non-Hodgkin lymphoma when medically necessary and no other curative-intent options exist; coverage includes all transplant-related steps (mobilization, harvesting, conditioning, and infusion). National Coverage Determination (NCD) 110.23 also provides national coverage for leukemia, aplastic anemia, SCID, and Wiskott–Aldrich syndrome, while certain conditions (MDS, specified multiple myeloma stages, high-risk myelofibrosis, severe sickle cell disease) are covered only within CMS-approved clinical studies (CED); required documentation must demonstrate disease severity, reasons for relapse/refractoriness, organ function, infection screening, support systems, and consideration of risk scores (EBMT or HCT-CI).
"Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is covered for primary refractory or relapsed Hodgkin lymphoma when the patient is medically necessary and has no other curative-inten..."