Single autologous hematopoietic cell transplantation (HCT) may be considered medically necessary as salvage therapy for germ cell tumors:in patients with favorable prognostic factors that have failed a previous course of conventional-dose salvage chemotherapy; or
in patients with unfavorable prognostic factors as initial treatment of first relapse (ie, without a course of conventional-dose salvage chemotherapy) and in patients with platinum-refractory disease. (See Policy Guidelines section for prognostic factors.)
Tandem autologous HCT or transplant with sequential high-dose chemotherapy may be considered medically necessary for the treatment of testicular tumors either as salvage therapy or with platinum-refractory disease.
Autologous HCT is considered investigational as a component of first-line treatment for germ cell tumors.
Allogeneic HCT is considered investigational to treat germ cell tumors, including, but not limited, to its use as therapy after a prior failed autologous HCT.