Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms

This policy covers allogeneic hematopoietic cell transplantation (allo‑HCT) as a medically necessary treatment for myelodysplastic syndromes and myeloproliferative neoplasms (examples include MDS, primary myelofibrosis, polycythemia vera, essential thrombocythemia, CML, juvenile myelomonocytic leukemia, systemic/cutaneous mastocytosis, MLN‑TK, etc.). Coverage is limited to patients who meet the Policy Guidelines — selection is individualized by disease risk, age, performance status and comorbidities; myeloablative conditioning is reserved for medically fit patients, reduced‑intensity conditioning is only for those who cannot tolerate myeloablation, and transplants not meeting criteria (including certain haploidentical or otherwise nonstandard scenarios) are considered experimental/unproven.

"Allogeneic hematopoietic cell transplantation is medically necessary as a treatment for myelodysplastic syndromes (per Policy Guidelines)."