Childhood Acute Lymphoblastic Leukemia
Autologous or allogeneic hematopoietic cell transplantation (HCT) may be considered medically necessary to treat childhood acute lymphoblastic leukemia (ALL) in first complete remission but at high-risk of relapse (for definition of high-risk factors, see Policy Guidelines section).
Autologous or allogeneic HCT may be considered medically necessary to treat childhood ALL in second or greater remission or refractory ALL.
Allogeneic HCT is considered medically necessary to treat relapsing ALL after a prior autologous HCT in children.
Adult Acute Lymphoblastic Leukemia
Autologous HCT may be considered medically necessary to treat adult ALL in first complete remission but at high-risk of relapse (for definition of high-risk factors, see Policy Guidelines section).
Allogeneic HCT may be considered medically necessary to treat adult ALL in first complete remission for any risk level (for definition of risk factors, see Policy Guidelines section).
Allogeneic HCT may be considered medically necessary to treat adult ALL in second or greater remission, or in adults with relapsed or refractory ALL.
Autologous HCT is investigational to treat adult ALL in second or greater remission or those with refractory disease.
Allogeneic HCT is considered medically necessary to treat relapsing adult ALL after a prior autologous HCT.
Reduced-intensity conditioning allogeneic HCT may be considered medically necessary as a treatment of ALL in patients who are in complete marrow and extramedullary first or second remission, and who, for medical reasons (see Policy Guidelines section), would be unable to tolerate a standard myeloablative conditioning regimen.
