Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas

This policy addresses autologous and allogeneic hematopoietic cell transplantation (HCT) for Non‑Hodgkin lymphomas, including salvage HCT for aggressive B‑cell subtypes that fail to achieve complete remission after a full course of standard‑dose induction, consolidation or salvage HCT for chemosensitive relapses (including diffuse large B‑cell lymphoma with high/high‑intermediate age‑adjusted IPI), autologous consolidation for mantle cell lymphoma, and selected uses in indolent B‑cell and mature T‑/NK‑cell neoplasms and hepatosplenic T‑cell lymphoma. Coverage requires prior full-course standard‑dose chemotherapy (HCT as initial therapy is investigational/not covered), is subject to member plan limits and state rules, and excludes or deems experimental certain indications (e.g., tandem transplants, some consolidative HCT in low‑risk DLBCL, and specified mantle cell or T‑cell allogeneic consolidations); myeloablative conditioning is limited to patients who are medically fit.