BlueCross BlueShield of Tennessee Medical Policy Manual

Progenitor Cell Therapy for the Treatment of Damaged Myocardium Due to Ischemia

DESCRIPTION

Progenitor cell therapy describes the use of various cell lineages (autologous or allogeneic) for tissue repair and/or regeneration. Often confused with adult stem cells, progenitor cells are early descendants of stem cells that can differentiate to form one or more kinds of cells, but cannot divide and reproduce indefinitely. A progenitor cell is often more limited than a stem cell in the kinds of cells it can become.  Progenitor cell therapy is being investigated for the treatment of damaged myocardium resulting from acute or chronic cardiac ischemia and for refractory angina in individuals who are not candidates for revascularization.

Ischemia is the most common cause of cardiovascular disease and myocardial damage in the developed world. Despite impressive advances in treatment, ischemic heart disease is still associated with high morbidity and mortality. Current treatments for ischemic heart disease seek to revascularize occluded arteries, optimize pump function, and prevent future myocardial damage. However, current treatments are unable to reverse existing heart muscle damage.

Infusion of growth factor (i.e., granulocyte colony stimulating factor [GCSF]) to accelerate the bone marrow's production of hematopoietic stem cells has also been researched as a treatment of damaged myocardium.

POLICY

See also:  Stem Cell Therapy for Peripheral Artery Disease

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

Published evidence-based studies and support by professional organizations regarding the utilization of progenitor cell therapy for the treatment of damaged myocardium are lacking. Progenitor cell therapy for the treatment of damaged myocardium is a rapidly evolving field, with a number of areas of substantial uncertainty including patient selection, cell type, and procedural details (e.g. timing and mode of delivery).

SOURCES

Afzal, M.R., Samanta, A., Shah, Z, Jeevanantham, V., Abdel-Latif, A., Zuba-Surma, E.K.,et al. (2015). Adult bone marrow cell therapy for ischemic heart disease: evidence and insights from randomized controlled trials. Circulation Research, 117 (6), 558-575. Abstract retrieved July 30, 2015 from PubMed database.

American College of Cardiology Foundation & American Heart Association. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Retrieved May 10, 2017 from http://circ.ahajournals.org/content/127/4/e362.figures-only.

BlueCross BlueShield Association. Medical Policy Reference Manual. (12:2016). Progenitor cell therapy for the treatment of damaged myocardium due to ischemia (2.02.18). Retrieved May 10, 2017 from BlueWeb. (22 articles and/or guidelines reviewed)

De Rosa, S., Seeger, F., Honold, J., MD; Fischer-Rasokat, U., Lehmann, R., Fichtlscherer, S., et. al., (2013) Procedural safety and predictors of acute outcome of intracoronary administration of progenitor cells in 775 consecutive procedures performed for acute myocardial infarction or chronic heart failure. Circulation: Cardiovascular Interventions, 6 (1), 44-51. (Level 2 evidence)

Xiao, C., Zhou, S., Liu, Y., & Hu, H. (2014). Efficacy and safety of bone marrow cell transplantation for chronic ischemic heart disease: a meta-analysis. Medical Science Monitor, 2014; 20:1768-1777. (Level 1 evidence)

Xu, R., Ding, S., Zhao, Y., Pu, J., & He, B. (2014). Autologous transplantation of bone marrow/blood-derived cells for chronic ischemic heart disease: a systematic review and meta-analysis. Canadian Journal of Cardiology, 30 (11), 1370-1377. Abstract retrieved May 9, 2017 from PubMed database.

Zhu, K., Li, J., Wang, Y., Luo, J., Guo, C., et al. (2015). Intramyocardial autologous bone marrow-derived stem cells injection for ischemic heart disease ineligible for revascularization: a systematic review and meta-analysis. Archives of Medical Research, 46 (4), 286-295. Abstract retrieved July 30, 2015 from PubMed database.

ORIGINAL EFFECTIVE DATE:  4/12/2007

MOST RECENT REVIEW DATE:  6/8/2017

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