BlueCross BlueShield of Tennessee Medical Policy Manual

Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas

DESCRIPTION

Hematopoietic stem-cell transplantation (HSCT) refers to a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer individuals who receive bone marrow-toxic doses of cytotoxic drugs with or without whole-body radiation. Autologous stem cell transplantation refers to the harvesting of stem cells from the transplant recipient and administering the cells to the same individual.

Astrocytomas are a type of brain cancer that originates from star-shaped brain cells in the cerebrum called astrocytes. Gliomas or glioblastomas are malignant tumors of the glial tissue of the nervous system. They are sometimes called anaplastic astrocytomas, glioblastoma multiforme, or oligodendroglioma. These tumors are classified histologically into 3 grades of malignancy: Grade II astrocytoma, grade III anaplastic astrocytoma, and grade IV glioblastoma multiform. Glioblastoma multiforme is the most malignant stage of astrocytoma. Oligodendrogliomas are diffuse neoplasms that are clinically and biologically most closely related to diffuse fibrillary astrocytomas.

Treatment of primary brain tumors focuses on surgery, either with curative intent or optimal tumor debulking. Surgery may be followed by radiation therapy and/or chemotherapy.

POLICY

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IMPORTANT REMINDERS

SOURCES 

American Brain Tumor Association. (2017). Glioblastoma and malignant astrocytoma. Retrieved August 2, 2017 from www.abta/org.

American Cancer Society. (2016). Treating specific types of adult brain and spinal cord tumors.  Retrieved August 2, 2017 from www.cancer.org.

American Cancer Society. (2016, January). Treating brain and spinal cord tumors in children. Retrieved August 2, 2017 from www.cancer.org.

Centers for Medicare & Medicaid Services. CMS.gov. NCD for stem cell transplantation (110.8.1). Retrieved October 28, 2015 from http://www.cms.gov.

Egan, G., Cervone, K., Philips, P., Belasco, J., Finlay, J., & Gardner, S. (2016). Phase I study of temozolomide in combination with thiotepa and carboplatin with autologous hematopoietic cell rescue in patients with malignant brain tumors with minimal residual disease. Bone Marrow Transplantation, 51 (4), 542-545. Abstract retrieved August 2, 2017 from PubMed database.

European Society for Medical Oncology (2014). High-grade glioma: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 25 (Suppl. 3), 93-101.

Lee, J., Lim, D., Sung, K., Lee, H., Yi, E., Yoo, K., et al. (2017). Tandem high-dose chemotherapy and autologous stem cell transplantation for high-grade gliomas in children and adolescents. Journal of Korean Medical Science, 32 (2), 195-203. (Level 4 evidence)

National Cancer Institute. (2017). Adult central nervous system tumors treatment (PDQ®). Retrieved August 2, 2017 from www.cancer.gov.

National Cancer Institute. (2017). Childhood astrocytomas treatment (PDQ®). Retrieved August 2, 2017 from www.cancer.gov.

National Comprehensive Cancer Network. (2016). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Central Nervous System Cancers, Version 1.2016. Retrieved September 1, 2016 from the National Comprehensive Cancer Network.

ORIGINAL EFFECTIVE DATE:  4/14/2011

MOST RECENT REVIEW DATE:  9/14/2017

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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