BlueCross and BlueShield of Montana Medical Policy/Codes
Stem-Cell Transplant for Miscellaneous Solid Tumors in Adults
Chapter: Transplant
Current Effective Date: October 25, 2013
Original Effective Date: July 09, 2008
Publish Date: October 25, 2013
Revised Dates: March 2010; January 2012; December 10, 2012; September 25, 2013
Description

The use of hematopoietic stem-cell transplantation (HSCT) has been investigated for treatment of patients with solid tumors in adults. Hematopoietic stem cells are infused to restore bone marrow function following cytotoxic doses of chemotherapeutic agents with or without whole body radiation therapy.

A solid tumor is defined as an abnormal mass of tissue that usually does not contain cysts or liquid areas. Different types of solid tumors are named for the type of cells that form them.

  • Gastrointestinal Tract Tumors include those of the colon, rectum, pancreas, stomach, esophagus, gallbladder and the bile duct.
  • Genitourinary Tract Tumors include renal cell carcinoma, and tumors of the cervix, uterus, fallopian tubes and prostate gland.
  • Head and Neck Tumors include nasopharyngeal, paranasal sinus, and other tumors of unspecified histology.
  • Malignant Melanoma is a serious type of skin cancer.
  • Neuroendocrine Tumors are cancers of the interface between the endocrine system and the nervous system.
  • Respiratory Tract Tumors include lung cancer of any type. 
  • Soft Tissue Sarcoma is a cancer that begins in the muscle, fat, fibrous tissue, blood vessels, or other supporting tissue of the body.
  • Thymus Gland Tumors are neoplasms located above the mediastinum or mid thoracic chest.
  • Thyroid Gland Tumors are neoplasms within the thyroid gland of the neck.
  • Unindentified Tumors include unknown primary site tumors, carcinoma of unknown primary origin, undifferentiated tumors or occult primary malignancy.

Stem cell transplant is an established treatment for certain hematologic malignancies, however, its use in solid tumors in adults continues to be largely experimental. Initial enthusiasm for the use of autologous transplant with the use of high dose chemotherapy (HDC) and stem cells for solid tumors has waned with the realization that dose intensification often fails to improve survival, even in tumors with a linear-dose response to chemotherapy. (1) With the advent of nonmyeloablative allogeneic transplant, interest has shifted to exploring the generation of alloreactivity to metastatic solid tumors via a graft-versus-tumor effect of donor-derived T cells. (2)

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply. If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Coverage

Coverage of, evaluation for, and subsequent single treatment by stem-cell transplant (SCT) (using bone marrow, peripheral blood, or umbilical cord blood as a stem-cell source), derived from a specific donor category, and following a chemotherapy regimen for treatment of *miscellaneous solid tumors in adults (see *NOTE for listing of miscellaneous tumors) is identified in the grid below.

NOTE: SCT may be known by different terminology and used interchangeably. Hereinafter, SCT will be known as stem-cell support (SCS) throughout the balance of this medical policy.

Allogeneic

Is considered experimental, investigational and unproven for solid tumors in adults.

Autologous

Is considered experimental, investigational and unproven for solid tumors in adults.

Tandem or Triple Stem-Cell Support

Is considered experimental, investigational and unproven for solid tumors in adults.

Donor Leukocyte Infusion

Is considered experimental, investigational and unproven for solid tumors in adults.

Hematopoietic Progenitor Cell Boost (Stem-Cell Boost)

Is considered experimental, investigational and unproven for solid tumors in adults.

Any use of short tandem repeat (STR) markers for the treatment of solid tumors in adults is considered experimental, investigational and unproven.

*NOTE:  Miscellaneous solid tumors in adults include, but are not limited to, any of the following:

  • Gastrointestinal tract tumors (esophagus, stomach, pancreas, gall bladder, bile duct, colon, rectal);
  • Genitourinary tract tumors (renal cell carcinoma, cervical carcinoma, cancer of the uterus, fallopian tubes, or prostate gland);
  • Head and neck tumors (nasopharyngeal, paranasal sinus, and other tumors of unspecified histology);
  • Malignant melanoma;
  • Neuroendocrine tumors;
  • Respiratory tract tumors (lung cancer of any type);
  • Soft tissue sarcoma;
  • Thymus gland tumors;
  • Thyroid gland tumors;
  • Unidentified tumors (unknown primary site tumors, carcinoma of unknown primary origin, undifferentiated tumors, or occult primary malignancy).

Rationale

High-dose chemotherapy (HDC) followed by hematopoietic stem-cell (HSC) transplant (HSCT) or stem-cell support (SCS) (i.e., blood or marrow) transplant is an effective treatment modality for many patients with certain malignancies and non-malignancies. The rationale of this treatment approach is to provide a very dose-intensive treatment in order to eradicate malignant cells followed by rescue with peripheral blood, umbilical cord blood, or bone marrow stem-cells. 

Initially, this policy was based on a 1995 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) Assessment (3) that reached the following conclusions:

  • While 125 articles were identified that reported on the results of high-dose chemotherapy (HDC) in a variety of solid tumors, only 17 included survival data from groups of patients with the same cancer.  These studies reported on four indications: advanced small-cell lung cancer, advanced colorectal cancer, malignant melanomas, and inoperable gastric cancer.
  • The evidence did not permit conclusions as to the effect of HDC on patient survival.

A separate 1999 Blue Cross Blue Shield Association (BCBSA) Technology Evaluation Center (TEC) Assessment (4) evaluated the use of HDC with allogeneic stem-cell support (AlloSCS) as a salvage therapy after a failed prior course of HDC with autologous stem-cell support (AuSCS) for solid tumors. Data were inadequate to permit conclusions.

A review by Nieto and Shpall (5), and a report from the European Group for Bone Marrow Transplantation's Solid Tumors Working Party (6) agreed that evidence was still insufficient to establish a definite role for HDC and autologous transplantation in small-cell lung cancer. Nieto and Shpall also concluded that evidence was inadequate to demonstrate a survival benefit from HDC for melanoma or sarcoma. Other solid tumor malignancies listed in the Coverage section of this document were not considered in either of these reviews. Uncontrolled pilot studies on HDC with hematopoietic SCS for patients with refractory urothelial carcinoma and recurrent or advanced nasopharyngeal carcinoma also provide inadequate evidence of improved outcomes to alter previous conclusions.

Autologous SCS in solid tumors of adults

Data on the use of autologous transplant for the solid tumors of adults addressed in this policy consists mainly of anecdotal reports and small series, and the number of randomized trials is limited.

Adult soft tissue sarcomas

The prognosis of patients with unresectable or metastatic soft tissue sarcomas is poor, with a median survival of about one year, and less than 10% 5-year survival.(7)  In general, dose-intensive doxorubicin and ifosfamide-based regimens have yielded higher response rates and prolonged disease free survival, but not overall survival. (7) However, as it was shown that patients who achieved complete remission (CR) had longer survival, several Phase I and II trials were conducted in the 1990s in an attempt to improve outcomes. (7) These trials were composed of small numbers of patients (ranging from 2-55), with HDC, yielding overall response rates from 20-65% with CR from 10-43%. The longest reported 5-year progression-free survival (PFS) rate was 21%, and 5-year overall survival (OS) was 32%. (7) One study of 21 patients with soft tissue sarcoma showed a PFS and OS benefit only in patients with no evidence of disease before receiving HDC. (8) The data from these small trials are insufficient to support the use of autologous SCS in adult patients with soft tissue sarcoma. In one additional Phase II study, 21 of 55 (38%) patients responded to doxorubicin-based induction chemotherapy (14 vs 3%; p = 0.003), but estimated OS was not statistically different between those that received the HDC and those that did not. The authors felt that their results warranted a Phase III trial examining the role of high dose chemotherapy as consolidation therapy in these patients. (9) No Phase III trials involving SCS for first line therapy of advanced or metastatic adult soft tissue sarcoma compared to conventional standard-dose chemotherapy were found in a systematic review.(10)

Small cell lung carcinoma (SCLC)

The interest in treating SCLC with SCS came from its extremely high chemosensitivity and poor prognosis. A phase III trial of 318 patients with SCLC randomly assigned patients to standard chemotherapy or HDC with SCS. (11)  No statistically significant difference in response rates was seen between the two groups (80% response rate in the standard arm versus 88% in the HDC group [difference = 8%, 95% confidence interval of -1% to 17%; p = .09]). There was no statistically significant difference in OS between the two groups, with a median OS of 13.9 months in the standard arm (95% confidence interval of 12.1-15.7 months) versus 14.4 months in the HDC arm (95% CI 13.1 to 15.4); p = .76. One smaller, randomized study and several single-arm studies of HDC and AuSCS for SCLC are summarized in a review article. (12) Overall, the majority of the data from these studies, including the randomized study, showed no increased overall survival with HDC and SCS.

A review article from Pedrazzoli and colleagues (13) summarizes the most recent data from studies of HDC with AuSCS for solid tumors in adults.

Allogeneic SCS in solid tumors of adults

Single-case reports and small series of patients with various types of solid tumors (1, 2, 14) have been treated with allogeneic hematopoietic stem cell transplantation, including some of the tumor types addressed in this policy.

Renal cell carcinoma

Metastatic renal cell carcinoma (RCC) has an extremely poor prognosis, with a median survival of less than one year and a 5-year survival of less than 5%. (15) RCC is relatively resistant to chemotherapy, but is susceptible to immune therapy, and interleukin-2 (IL-2) and/or interferon alpha have induced responses and long-term progression-free survival in 4-15% of patients. (14) Therefore, the immune-based strategy of a graft-versus-tumor effect possible with an allogeneic transplant has led to an interest in its use in RCC. In 2000, Childs and co-workers published the first series of patients with RCC treated with nonmyeloablative AlloSCS. (15) The investigators showed regression of the tumor in 10 of 19 (53%) patients with cytokine-refractory, metastatic RCC who received an HLA-identical sibling AlloSCS. Three patients had a complete response, and remained in remission 16, 25 and 27 months after transplant. Four of seven patients with a partial response were alive without disease progression 9-19 months after transplantation. Other pilot trials have demonstrated the graft-versus-tumor effect of allogeneic transplant in metastatic RCC, but most have not shown as high a response rate as the Childs’ study. Overall response rates in these pilot trials have been about 25%, with complete response rates of about 8%. (1) Prospective, randomized trials are needed to assess the net impact of this technique on the survival of patients with cytokine-refractory RCC. (1)

Clinical Guidelines

National Comprehensive Cancer Network (NCCN) Guidelines:

In addition, the National Comprehensive Cancer Network (NCCN) guidelines on the tumors addressed in this policy have not indicated stem cell transplant as a treatment option. (16)

National Cancer Institute (NCI) Clinical Trials Database (PDQ®)

To date, no clinical trials have been published that would alter the policy statement. An August 2008 search of the National Cancer Institute (NCI) database of ongoing clinical trials (Physician Data Query [PDQ®] database) shows a Phase III clinical trial of chemotherapy followed by peripheral stem cell or bone marrow transplant compared with chemotherapy alone in treating patients with SCLC conditioning regimens followed by autologous stem cell transplantation (single or tandem) in patients with hematologic malignancies or solid tumors (NCT00536601). No additional ongoing Phase III clinical trials of chemotherapy followed by stem cell transplantation in treating adults with miscellaneous solid tumors listed in this policy were identified.

Additional Infusion Treatments for Solid Tumors in Adults

Search of published literature did not locate any random, controlled studies that indicate improved patient outcomes for tandem or triple SCS, or donor leukocyte infusion (DLI).

2013 Update

A search of peer reviewed literature through October 2012 was conducted. The following is a summary of the key literature to date.

Autologous SCS in solid tumors of adults

Adult soft tissue sarcomas

Kasper and colleagues reported the results of a prospective, single institution Phase 2 study that enrolled 34 patients with advanced and/or metastatic soft tissue sarcoma. (17) After 4 courses of chemotherapy, patients with at least a partial response underwent HDC and AuSCS (n=9). All other patients continued chemotherapy for 2 more cycles. The median PFS for patients treated with HSCS was 11.6 months (range 8-15 months) versus 5.6 months for patients treated with standard chemotherapy (p=0.047) and median OS for the 2 groups was 23.7 months (range 12-34 months) versus 10.8 months (range 0-39 months) (p=0.027), respectively. The improved PFS and OS observed in the HSCS group probably reflected chemoresponse; however, this would need to be addressed in a randomized study.

Small cell lung carcinoma (SCLC)

Jiang and colleagues performed a meta-analysis of the medical literature through October 2008 of English language studies using intensified chemotherapy with autologous hematopoietic progenitors to treat SCLC. (18) The meta-analysis consisted of 5 randomized, controlled trials (RCTs); 3 were Phase III trials and 2 were Phase II), for a total of 641 patients. They found no significant increase in the odds ratio for response rate with autologous transplant versus control chemotherapy (odds ratio [OR]: 1.29; 95% CI: 0.87–1.93; p=0.206). No statistically significant increase in OS was seen among the autologous transplant patients compared to control regimens (hazard ratio [HR]: 0.94; 95% CI: 0.80–1.10; p=0.432). The authors concluded that current evidence does not support the use of intensified chemotherapy and autologous HSCS for treating SCLC.

Miscellaneous

Uncontrolled pilot studies of HSCS for patients with refractory urothelial carcinoma (19) and recurrent or advanced nasopharyngeal carcinoma (20) failed to provide adequate evidence of improved outcomes to alter previous conclusions.

Allogeneic HSCS in Solid Tumors of Adults

Renal cell carcinoma (RCC)

Bregni and colleagues assessed the long-term benefit of allografting in 25 patients with cytokine-refractory metastatic RCC who received an RIC allograft from a sibling who is HLA identical. (21) All patients received the same conditioning regimens. Response to allograft was available in 24 patients, with a CR in 1 patient and partial response in 4 patients. Twelve patients had minor response or stable disease, and 7 reported progressive disease. Overall response rate (complete plus partial) was 20%. Six patients died because of transplant-related mortality. Median survival was 336 days (12–2,332+). One-year OS was 48% (95% CI: 28–68), and 5-year OS was 20% (95% CI: 4–36). The authors concluded that allografting is able to induce long-term disease control in a small fraction of cytokine-resistant patients with RCC but that with the availability of novel targeted therapies for RCC; future treatment strategies should consider the incorporation of these therapies into the transplant regimen.

Colorectal carcinoma

Aglietta and colleagues reported their experience with 39 patients with metastatic colorectal cancer who underwent reduced-intensity conditioning (RIC) allogeneic HSCS between 1999 and 2004 at 9 European Group for Blood and Marrow Transplantation (EBMT) centers. (22) Patients were treated with 1 of 5 different RIC regimens. Endpoints that were assessed were achievement of mixed chimerism, incidence of graft-versus-host disease (GVHD), treatment-related mortality and toxicities, OS, and time to treatment failure (in patients who responded to the therapy). Patient population characteristics were heterogeneous; pretransplant disease status was partial response in 2 patients, stable disease in 6 patients, and progressive disease in 31. Thirty-eight patients (97%) had been previously treated, some with only chemotherapy and others with surgery and/or chemotherapy. After transplant, tumor responses were complete in 2% of patients; partial in 18%; and 26% of patients had stable disease, for overall disease control in 46% of patients. Transplant-related mortality was 10%. Median overall follow-up was 202 days (range: 6–1,020 days), after which time 33 patients had died and 6 were still alive. Tumor progression was the cause of death in 74% of patients. A comparison of OS of patients was performed after stratifying by some potential prognostic factors. Achievement of response after transplantation was associated with a difference in OS, with the 18 patients who had a response having a median OS of approximately 400 days versus approximately 120 days for those who had no response (p=0.00018). The authors concluded that the HSCS approach should probably be reserved for patients with a partial response or stable disease after second-line therapy for metastatic colorectal cancer and that second-generation clinical trials in these patients are warranted.

Pancreatic cancer

Kanda and colleagues reported on the efficacy of reduced intensity conditioning AlloSCS against advanced pancreatic cancer in 22 patients from 3 transplantation centers in Japan. (23) The RIC regimens differed among the centers, and the patient population was fairly heterogeneous, with 15 patients having metastatic disease and 7 locally advanced disease. All but 1 patient received chemotherapy of various combinations before transplant, and 10 patients received local radiation. After HSCS, 1 patient achieved complete response, 2 patients had partial response, 2 had minor response, and 8 had stable disease, with an overall response rate of 23%. Median survival was 139 days, and the major cause of death was tumor progression (median duration of survival in advanced pancreatic cancer in the non-transplant setting is less than 6 months, even in patients treated with gemcitabine). Only 1 patient survived longer than 1 year after transplantation. The authors concluded that a tumor response was observed in one fourth of patients with advanced pancreatic cancer who underwent HSCS and that the response was not durable. However, they felt that their observation of a relationship between longer survival and the infusion of a higher number of CD34-positive cells or the development of chronic GVHD warrant future studies to enhance the immunologic effect against pancreatic cancer.

Abe and colleagues reported the outcomes for 5 patients with chemotherapy-resistant, unresectable pancreatic adenocarcinoma who received a nonmyeloablative allogeneic peripheral blood HSCS. (24) The conditioning regimen consisted of fludarabine and low-dose total-body irradiation. The median patient age was 54 years (range: 44–62 years). All patients had advanced disease, either with metastases or peritonitis, and had received at least 1 course of chemotherapy including gemcitabine. After HSCS, tumor response was only observed in 2 patients—1 had complete disappearance of the primary tumor and 1 had a 20% reduction in tumor size; the remaining patients had progressive disease (n=2) or stable disease (n=1). Four patients died of progressive disease, ranging from post-transplant day 28 to day 209 (median: 96 days). One patient died at day 57 secondary to rupture of the common bile duct from rapid tumor regression. The authors concluded that their study showed a graft-versus-tumor effect but that in order to obtain durable responses, an improved conditioning regimen and new strategies to control tumor growth after nonmyeloablative AlloSCS are needed.

Nasopharyngeal carcinoma

Toh and colleagues reported the outcomes of a Phase 2 trial of 21 patients with pretreated metastatic nasopharyngeal carcinoma. (25) Median patient age was 48 years (range: 34-57 years), and patients had received a median of 2 previous chemotherapy regimens (range; 1-8). All patients had extensive metastases. Patients underwent a nonmyeloablative allogeneic HSCS with sibling allografts. Seven patients (33%) showed a partial response and 3 (14%) achieved stable disease. Four patients were alive at 2 years, and 3 showed prolonged disease control of 344, 525, and 550 days. After a median follow-up of 209 days (range: 4-1,147 days), the median PFS was 100 days (95% CI: 66-128 days), and median OS was 209 days (95% CI: 128-236 days). One and 2-year OS rates were 29 and 19%, respectively, comparable to the median 7-14 months OS for metastatic nasopharyngeal patients in the literature treated with salvage chemotherapy without HSCS.

Additional Infusion Treatments for Miscellaneous Solid Tumors in Adults Using Hematopoietic Progenitor Cell (HPC) Boost or Stem-Cell Boost (SCB)

As with DLI, HPC Boost has a positive response rate for relapse following AlloSCS. (26) The boost of stem-cells, a second dose, may be helpful to reduce the graft failure process, avoiding the risk of serious bleeding and/or infection. However, the data is insufficient for the use of HPC Boost following AlloSCS for treatment of non-hematological malignancies to lessen post-transplant graft failuress. (26, 27, 28, 29)

Short Tandem Repeat (STR) Markers

Following SCS therapy, it is important to determine whether the new blood forming system is of the donor or the recipient, based upon the proportion of donor and recipient cells. The characteristics of the engraftment are analyzed, which is called chimerism analysis. Using STR marker assay to characterize the hematological course and to evaluate the usefulness of the blood forming system (particularly for hematological malignancies, myelodysplastic/myeloproliferative processes, or certain genetic or metabolic disorders) has been tested initially after the SCS, when the patient is declared as disease-free, and at the point of the confirmed stable engraftment of only the donor pattern of the blood forming system. (30, 31) Without further randomized trials using STR markers prior to or post SCS therapy for treatment of miscellaneous solid tumors in adults, the data is insufficient to determine the outcome/effect of stem-cell engraftment. (30, 31, 32, 33, 34, 35)

Clinical Guidelines

National Comprehensive Cancer Network (NCCN) Guidelines:

The 2012 National Comprehensive Cancer Network (NCCN) guidelines on the tumors addressed in this policy do not indicate HSCS as a treatment option. (16)

National Cancer Institute (NCI) Clinical Trials Database (PDQ®):

An October 2012 search of the online site of the NCI Clinical Trial Database (PDQ®) revealed no ongoing Phase III clinical trials of chemotherapy followed by HSCS in treating adults with miscellaneous solid tumors listed in this policy were identified.

Summary

In summary, as of October 2012, no clinical trials have been published that would alter the current policy statement; thus the use of HSCS, as a single treatment or infusion, tandem or triple stem-cell transplant and DLI in solid tumors, listed in the coverage statement, for adults remains experimental, investigational and unproven.

Based on a search of scientific literature in the MedLine database through March 2013, HPC boost to reduce the graft failure process and STR markers to monitor engraftment chimerism for the treatment of solid tumors in adults are considered experimental, investigational, and unproven due to the lack of adequate evidence of safety and effectiveness documented in published, peer-reviewed medical literature.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps. 

ICD-9 Codes

Experimental, Investigational and Unproven for all codes.  41.00, 41.01, 41.02, 41.03, 41.04, 41.05, 41.06, 41.07, 41.08, 41.09, 41.91, 99.25, 99.74, 99.79

ICD-10 Codes

Experimental, Investigational and Unproven for all codes.  30230G0, 30230G1, 30233G0, 30233G1, 30240G0, 30240G1, 30243G0, 30243G1, 30250G0, 30250G0, 30250G1, 30253G0, 30253G1, 30260G0, 30260G1, 30263G0, 30263G1, 3E03005, 3E03305, 3E04005, 3E04305, 3E05005, 3E05305, 3E06005, 3E06305, 6A550Z2, 6A551Z2, 6A550ZT, 6A550ZV, 6A551ZT, 6A551ZV

Procedural Codes: 36511, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, 38213, 38214, 38215, 38220, 38221, 38230, 38232, 38240, 38241, 38242, 38243, 81265, 81266, 81267, 81268, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 86805, 86806, 86807, 86808, 86812, 86813, 86816, 86817, 86821, 86822, 86825, 86826, 86828, 86829, 86830, 86831, 86832, 86833, 86834, 86835, 86849, 86950, 86985, 88240, 88241, S2140, S2142, S2150
References
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  2. Carnevale-Schianca F, Ricchiardi A, Capaldi A et al. Allogeneic hemopoietic stem cell transplantation in solid tumors. Transplant Proc 2005; 37(6):2664-6.
  3. High-Dose Chemotherapy with Autologous Stem-Cell Support for Miscellaneous Solid Tumors in Adults. Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1995 May) 10(4):1-27.
  4. Salvage HDC/AlloSCT for Relapse following HDC/AuSCT for Non-lymphoid Solid Tumors. Chicago, Illinois: Blue Cross Blue Shield Association – Technology Evaluation Center Assessment Program (1999 July) 14(11):1-10.
  5. Nieto Y, Shpall EJ. Autologous stem-cell transplantation for solid tumors in adults. Hematol Oncol Clin North Am 1999; 13(5):939-68.
  6. Rosti G, Ferrante P, Ledermann J et al. High-dose chemotherapy for solid tumors: results of the EBMT. Crit Rev Oncol Hematol 2002; 41(2):129-40.
  7. Pedrazzoli P, Ledermann JA, Lotz JP et al. High dose chemotherapy with autologous hematopoietic stem cell support for solid tumors other than breast cancer in adults. Ann Oncol 2006; 17(10):1479-88.
  8. Kasper B, Dietrich S, Mechtersheimer G et al. Large institutional experience with dose-intensive chemotherapy and stem cell support in the management of sarcoma patients. Oncology 2007; 73(1-2):58-64.
  9. Schlemmer M, Wendtner CM, Falk M et al. Efficacy of consolidation high-dose chemotherapy with ifosfamide, carboplatin and etoposide (HD-ICE) followed by autologous peripheral blood stem cell rescue in chemosensitive patients with metastatic soft tissue sarcomas. Oncology 2006; 71(1-2):32-9.
  10. Verma S, Younus J, Stys-Norman D et al. Dose-intensive chemotherapy with growth factor or autologous bone marrow/stem cell transplant support in first-line treatment of advanced or metastatic adult soft tissue sarcoma: a systematic review. Cancer 2008; 112(6):1197-205.
  11. Lorigan P, Woll PJ, O’Brien ME et al. Randomized phase III trial of dose-dense chemotherapy supported by whole-blood hematopoietic progenitors in better-prognosis small-cell lung cancer. J Natl Cancer Inst 2005; 97(9):666-74.
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  14. Demirer T, Barkholt L, Blaise D et al. Transplantation of allogeneic hematopoietic stem cells: an emerging treatment modality for solid tumors. Nat Clin Pract Oncol 2008; 5(5):256-67.
  15. Childs R, Chernoff A, Contentin N et al. Regression of metastatic renal cell carcinoma after nonmyeloablative allogeneic peripheral blood stem cell transplantation. N Engl J Med 2000; 343(11):750-8.
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  20. Airoldi M, De Crescenzo A, Pedani F et al. Feasibility and long-term results of autologous PBSC transplantation in recurrent undifferentiated nasopharyngeal carcinoma. Head Neck 2001; 23(9):799-803.
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  33. Odriozola, A., Riancho, J.A., et al. Evaluation of the sensitivity of two recently developed STR multiplexes for the analysis of chimerism after hematopoietic stem-cell transplantation. International Journal of Immunogenetics (2013 April) 40(2):88-92.
  34. Lawler, M., Crampe, M., et al. The EuroChimerism concept for standardized approach to chimerism analysis after allogeneic stem-cell transplantation. Leukemia (2012 August) 26(8):1821-8.
  35. Tilanus, M.G. Short tandem repeat markers in diagnostics: what’s in a repeat? Leukemia (2006 August) 20(8):1353-55. Available at http://www.nature.com  (accessed – 2013 April 22).
  36. Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2011 September) Therapy 8.01.24
  37. Donor Leukocyte Infusion for Hematologic Malignancies Treated with Stem-Cell Transplant. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2012 May) Medicine: 2.03.03.
History
June 2012 Policy Reviewed: Revised Not Medically Necessary statement to Investigational; updated rationale and references
December 2012 Policy updated with literature review using MEDLINE through September 2012; no references added. Policy statement unchanged.  Coding updated.  Title changed from "Transplant: High-Dose Chemotherapy and Hematopoietic Stem-Cell Support to Treat Solid Tumors in Adults" to "hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults".
October 2013 Policy formatting and language revised.  Policy statement unchanged.  Title changed from "Hematopoietic Stem-Cell Transplantation for Miscellaneous Solid Tumors in Adults" to "Stem-Cell Transplant for Miscellaneous Solid Tumors in Adults".
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Stem-Cell Transplant for Miscellaneous Solid Tumors in Adults