Hematopoietic Cell Transplantation for Hodgkin Lymphoma (HL)

This policy covers hematopoietic cell transplantation (autologous and allogeneic HCT) for treatment of Hodgkin lymphoma—including classical subtypes—for patients with primary refractory or relapsed disease and as salvage for first relapse meeting specified poor‑risk criteria. Major limitations/requirements: HCT as routine first‑line consolidation, tandem or second autologous HCT, and unspecified HCT uses are considered experimental/investigational; pathology confirmation, adherence to donor‑selection hierarchy (HLA‑identical sibling preferred, matched unrelated or haploidentical when needed), and adequate medical fitness for myeloablative conditioning are required.

"Hematopoietic cell transplantation for treatment of Hodgkin lymphoma (policy title indicates coverage related to HL)"

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