BlueCross BlueShield of Tennessee Medical Policy Manual

Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults

DESCRIPTION

Hematopoietic stem cell transplantation (HSCT) refers to a procedure in which hematopoietic stem cells are infused to restore bone marrow function in individuals who receive bone marrow-toxic doses of cytotoxic drugs with or without whole body radiotherapy. Hematopoietic stem cells can be harvested from bone marrow, peripheral blood or from umbilical cord blood shortly after delivery of neonates. Although cord blood is an allogeneic source, the stem cells in it are antigenically “naive” and thus are associated with a lower incidence of rejection or graft-versus-host disease.

Autologous HSCT typically occurs after induction chemotherapy once complete remission has been achieved.  The individual’s stem cells are mobilized from the bone marrow to the peripheral bloodstream and harvested.  High dose chemotherapy is administered to eradicate any lingering cancer cells followed by reinfusion of the stem cells.  

Allogeneic HSCT involves stem cells collected from a donor who is selected based on the results of human leukocyte antigen (HLA) typing.  A close HLA match increases the likelihood of a successful transplant.  Prior to the transplant, the recipient undergoes intensive treatment to destroy cancerous cells.  The donor cells are infused into the bloodstream and travel to the bone marrow where they begin to produce new cells in a process known as engraftment.

HSCT is an established treatment for certain hematologic malignancies; however, its use in solid tumors in adults continues to be largely experimental.

POLICY

For Neuroblastoma, please refer to the MCG Care Guideline - Medical Oncology GRG

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Peer reviewed studies on the use of autologous or allogeneic stem cell transplantation in the treatment of solid tumors in adults are limited.  There is insufficient evidence to permit conclusions regarding improved health outcomes.

SOURCES   

American Society for Blood and Marrow Transplantation. (2015). Indications for autologous and allogeneic hematopoietic cell transplantation: guidelines from the American Society for Blood and Marrow Transplantation. Retrieved October 21, 2015 from http://www.asbmt.org.

BlueCross BlueShield Association. Evidence Positioning System. (1:2018). Hematopoietic cell transplantation for miscellaneous solid tumors in adults (8.01.24). Retrieved October 23, 2018 from https://www.evidencepositioningsytem.com/  (33 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. (2016, October) NCD for stem cell transplantation (110.23). Retrieved December 12, 2017 from http://www.cms.gov.

Engelhardt, M., Zeiser, R., Ihorst, G., Finke, J., & Müller, C. (2007). High-dose chemotherapy and autologous peripheral blood stem cell transplantation in adult patients with high-risk or advanced Ewing and soft-tissue sarcoma. Journal of Cancer Research & Clinical Oncology, 133, 1-11. (Level 4 evidence)

ESMO/European Sarcoma Network Working Group. (2014). Soft tissue and visceral sarcomas: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 25 (Supplement 3), iii102-iii112. Retrieved November 17, 2016 from https://annonc.oxfordjournals.org.

National Comprehensive Cancer Network. (2018). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Accessed October 23, 2018 from the National Comprehensive Cancer Network.

Sureda, A., Bader, P., Cesaro, S., Dreger, P., Duarte, R., Dufour, C., et al. (2015). Indications for allo- and auto-SCT for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2015. Bone Marrow Transplantation, 50, 1037-1056. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  5/14/2011

MOST RECENT REVIEW DATE:  12/13/2018

ID_BT

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