Stem-Cell Transplant for Miscellaneous Solid Tumors in Adults
© Blue Cross and Blue Shield of Montana
Current Effective Date:
October 25, 2013
Original Effective Date:
July 09, 2008
October 25, 2013
March 2010; January 2012; December 10, 2012; September 25, 2013
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)
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
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- Imanguli MM, Childs RW. Hematopoietic stem cell transplantation for solid tumors. Update Cancer Ther 2006; 1(3):343-52.
- Carnevale-Schianca F, Ricchiardi A, Capaldi A et al. Allogeneic hemopoietic stem cell transplantation in solid tumors. Transplant Proc 2005; 37(6):2664-6.
- 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.
- 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.
- Nieto Y, Shpall EJ. Autologous stem-cell transplantation for solid tumors in adults. Hematol Oncol Clin North Am 1999; 13(5):939-68.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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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- Pedrazzoli P, Rosti G, Secondino S et al. High-dose chemotherapy with autologous hematopoietic stem cell support for solid tumors in adults. Semin Hematol 2007; 44(4):286-95.
- 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.
- 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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- Kasper B, Scharrenbroich I, Schmitt T et al. Consolidation with high-dose chemotherapy and stem cell support for responding patients with metastatic soft tissue sarcomas: prospective, single-institutional phase II study. Bone Marrow Transplant 2010; 45(7):1234-8.
- Jiang J, Shi HZ, Deng JM et al. Efficacy of intensified chemotherapy with hematopoietic progenitors in small-cell lung cancer: a meta-analysis of the published literature. Lung Cancer 2009; 65(2):214-8.
- Nishimura M, Nasu K, Ohta H et al. High dose chemotherapy for refractory urothelial carcinoma supported by peripheral blood stem cell transplantation. Cancer 1999; 86(9):1827-31.
- 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.
- Bregni M, Bernardi M, Servida P et al. Long-term follow-up of metastatic renal cancer patients undergoing reduced-intensity allografting. Bone Marrow Transplant Feb 23 2009; [Epub ahead of print].
- Aglietta M, Barkholt L, Schianca FC et al. Reduced-intensity allogeneic hematopoietic stem cell transplantation in metastatic colorectal cancer as a novel adaptive cell therapy approach. The European Group for Blood and Marrow Transplantation experience. Biol Blood Marrow Transplant 2009; 15(3):326-35.
- Kanda Y, Omuro Y, Baba E et al. Allo-SCT using reduced-intensity conditioning against advanced pancreatic cancer: a Japanese survey. Bone Marrow Transplant 2008; 42(2):99-103.
- Abe Y, Ito T, Baba E et al. Nonmyeloablative allogeneic hematopoietic stem cell transplantation as immunotherapy for pancreatic cancer. Pancreas 2009; 38(7):815-9.
- Toh HC, Chia WK, Sun L et al. Graft-vs-tumor effect in patients with advanced nasopharyngeal cancer treated with nonmyeloablative allogeneic PBSC transplantation. Bone Marrow Transplant 2011; 46(4):573-9.
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- Slatter, M.A., Bhattacharya, A., et al. Outcome of boost hematopoietic stem cell transplant for decreased donor chimerism or graft dysfunction in primary immunodeficiency. Bone Marrow Transplantation (2005) 35:683-9.
- Larocca, A., Piaggio, G., et al. A boost of CD35+-selected peripheral blood cells without further conditioning in patients with poor graft function following allogeneic stem cell transplantation. The Hematology Journal (2006) 91(7):935-40.
- NIH – Marrsson, J., Ringden, O., et al. Graft failure after allogeneic hematopoietic cell transplantation. Biology and Blood Marrow Transplant (2008 January) 14(Supplement 1):165-70. National Institutes of Health Public Access. Available at http://www.nih.gov (accessed – 2013 April 15).
- Borrill, V., Schlaphoff, T., et al. The use of short tandem repeat polymorphisms for monitoring chimerism follow bone marrow transplantation: a short report. Hematology (2008 August) 13(4):210-4.
- Crow, J., Youens, K., et al. Donor cell leukemia in umbilical cord blood transplant patients: a case study and literature review highlighting the importance of molecular engraftment analysis. Journal of Molecular Diagnostics (2010 July) 12(4):530-7.
- Park, M., Koh, K.N., et al. Clinical implications of chimerism after allogeneic hematopoietic stem-cell transplantation in children with non-malignant diseases. Korean Journal of Hematology (2011 December) 46(4):258-64.
- 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.
- 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.
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- 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
- 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.
||Policy Reviewed: Revised Not Medically Necessary statement to Investigational; updated rationale and references|
||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".|
||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".|