Hematopoietic Cell Transplantation for Acute Myeloid Leukemia

This policy covers hematopoietic cell transplantation (allogeneic or autologous HCT) as a post‑remission treatment for acute myeloid leukemia (AML), including myeloablative allogeneic HCT for poor‑ to intermediate‑risk AML in first complete remission (CR1), refractory or relapsed disease brought into complete remission, treatment‑related AML, AML with antecedent hematologic disease, and other high‑risk features (e.g., circulating blasts, monocytoid differentiation). Coverage requires appropriate donor selection (HLA‑identical sibling preferred; matched unrelated donors acceptable; haploidentical donors when other options unavailable), appropriate conditioning intensity (myeloablative for medically fit patients; reduced‑intensity when MAC is not tolerated), demonstrated responsiveness to intensified induction for autologous HCT candidates, and is subject to member benefit plan limits — HCT is considered investigational if policy criteria are not met.

"Hematopoietic cell transplantation for the treatment of acute myeloid leukemia (AML) when medically indicated."