Hematopoietic Cell Transplantation for Solid Tumors of Childhood

This policy covers autologous hematopoietic cell transplantation (HCT)—using bone marrow, peripheral blood, or umbilical cord blood stem cells, including single or tandem autologous transplants—for treatment of high‑risk, metastatic, recurrent, or refractory childhood solid tumors, most notably high‑risk neuroblastoma (including tandem HCT), high‑risk or relapsed Ewing sarcoma, metastatic retinoblastoma, and high‑risk relapsed Wilms tumor. Coverage is subject to the member’s benefit plan and applicable regulations; autologous HCT is considered investigational for low‑ or intermediate‑risk disease and many tumors not specifically listed, tandem HCT is investigational except for high‑risk neuroblastoma, and allogeneic HCT (including salvage allogeneic) is considered experimental/unproven for pediatric solid tumors.

"Autologous hematopoietic cell transplantation (HCT) for treatment of solid tumors of childhood."