Hematopoietic Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma (MM) and POEMS Syndrome

This policy covers hematopoietic cell transplantation (HCT) for plasma cell dyscrasias, principally autologous (single, salvage, and select tandem sequences) and consideration of HCT for POEMS syndrome and symptomatic or progressive multiple myeloma (MM). Coverage focuses on MM patients requiring initiation of therapy for symptoms or end‑organ damage and on disseminated POEMS, while limiting tandem autologous HCT to those who fail to achieve at least a near‑complete or very good partial response after the first transplant, treating routine/early intervention for asymptomatic MGUS/smoldering MM as not indicated, and designating allogeneic HCT for MM or POEMS as experimental/unproven (with POEMS requiring specified diagnostic criteria).

"Single autologous hematopoietic cell transplantation (HCT) is medically necessary to treat multiple myeloma (MM)."

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