Autologous hematopoietic cell transplantation may be considered medically necessary for:
initial treatment of high-risk neuroblastoma,
recurrent or refractory neuroblastoma,
initial treatment of high-risk Ewing sarcoma,
recurrent or refractory Ewing sarcoma, and
metastatic retinoblastoma.
Tandem autologous hematopoietic cell transplantation may be considered medically necessary for high-risk neuroblastoma.
Autologous hematopoietic cell transplantation is considered investigational as initial treatment of low- or intermediate-risk neuroblastoma, initial treatment of low- or intermediate-risk Ewing sarcoma, and for other solid tumors of childhood including, but not limited, to the following:
rhabdomyosarcoma,
Wilms tumor,
osteosarcoma, and
retinoblastoma without metastasis.
Tandem autologous hematopoietic cell transplantation is considered investigational for the treatment of all other types of pediatric solid tumors except high-risk neuroblastoma, as noted above.
Allogeneic (myeloablative or nonmyeloablative) hematopoietic cell transplantation is considered investigational for treatment of pediatric solid tumors.
Salvage allogeneic hematopoietic cell transplantation for pediatric solid tumors that relapse after autologous transplant or fail to respond is considered investigational.
