HEMATOPOIETIC STEM CELL TRANSPLANTATION
|
ALTERNATE NAMES
|
Allogeneic HCT; Allogeneic HSCT; Autologous HCT; Autologous HSCT; Bone Marrow Transplant;
Bone Marrow Transplantation; Cord Blood Transplant; HCT; Hematopoietic Progenitor
Cell Transplant; Hematopoietic Progenitor Cell Transplantation; HPCT; HSC; HSCT ;
LT-HSC; Multipotent Progenitor; Peripheral Blood Stem Cell Transplant; Stem Cell Transplant;
Stem Cell Transplantation
|
DESCRIPTION
|
Hematopoietic stem cell transplantation (HSCT), also known as stem cell transplantation or bone marrow transplantation, involves
administering healthy hematopoietic stem cells, which are immature cells found in
bone marrow and peripheral blood that can develop into red blood cells, platelets,
and white blood cells, to individuals with dysfunctional or depleted bone marrow.
Different hematopoietic stem cell sources may be used in HSCT, including peripheral
blood stem cells, bone marrow stem cells, and cord blood stem cells.
There are two main types of HSCT:
-
•
Autologous – the transplanted cells come from the patient; and
-
•
Allogeneic – the transplanted cells come from a donor.
HSCT does not include immunotherapies (immune effector cell therapies), such as chimeric
antigen receptor T cell (CAR-T cell) therapy.
An individual’s immune system remains impaired for up to 12 months after receiving
an HSCT and the individual generally remains severely immunocompromised. There is
high risk of the underlying condition(s) returning, developing new organ damage, or
developing severe infections or diseases. Because of the severe immune
compromise, the high risk of complications, and the difficult recovery period during
this time, the 12 months after the date of transplantation is considered CAL-level
impairment. Note: Complications do not have to occur in order to meet CAL
requirements.
HSCT can be used to treat several malignant (cancerous) conditions, such as leukemias
or lymphomas, and non-malignant conditions, such as conditions involving dysfunction
of the hematological or immune systems, in adults and children. HSCT may also be used
to treat conditions such as multiple sclerosis or Hurler’s syndrome.
|
DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9-CM/ICD-10-CM CODING
|
Diagnostic testing: Diagnostic testing is completed after the HSCT to monitor engraftment (when transplanted
stem cells produce mature cells), detect relapse, identify graft failure, and assess
graft-versus-host-disease (GVHD).
An individual may experience side effects and complications related to the transplant
or post-transplant treatment. Testing to diagnose these conditions will vary based
on the type of condition and the symptoms each individual may experience.
Physical findings: An individual may experience severe complications after receiving an HSCT. These
complications usually occur because of the conditioning regimen, also known as a preparative
regimen, which includes the use of high-dose chemotherapy or total body irradiation
or both to destroy bone marrow cells in order to create space in the bone marrow for
the healthy stem cells to engraft and to suppress the immune system. Other complications
occur because the transplanted hematopoietic stem cells did not engraft; or once engrafted,
treat the recipient’s body as foreign and attack it.
The most common complications that occur after an HSCT are acute or chronic GVHD and
pancytopenia. Other complications can include frequent or life-threatening infections
or deterioration of organ systems. These complications usually occur in the first
12 months after transplantation.
An individual with pancytopenia may experience signs and symptoms that may include:
-
•
Anemia (low red blood cells);
-
•
Leukopenia (low white blood cells);
-
•
Thrombocytopenia (low platelets);
-
•
Easy bruising and bleeding; and
Acute or chronic GVHD generally affects the skin, gastrointestinal tract, and liver.
Signs and symptoms of GVHD may include:
-
•
Bullous lesions (large, fluid-filled blisters (bullae) on the skin or mucous membranes);
-
•
Dryness or painful sores in the mouth;
-
•
Yellowing of the skin and eyes (jaundice);
-
•
Elevated bilirubin and alkaline phosphatase levels;
-
•
Severe coagulopathy (impaired ability for blood to clot);
-
•
Severe hyperammonemia (high levels of ammonia in the blood);
-
•
Enlarged liver (hepatomegaly);
ICD-9: 279.5; 284.1; 996.85; 999.89; V42.81; V42.82
ICD-10: D61.81; D61.89; D89.810; D89.811; D89.812; T86.0; T86.5
|
PROGRESSION
|
HSCT recipient survival rates vary greatly depending on a number of factors, including
the underlying condition and patient- and donor-related factors. There has been some
improvement in survival due to advances in HSCT methods and supportive care and it
is now a potentially curative treatment for some conditions. Despite these improvements,
disease relapse and acute and chronic complications continue to affect survival rates.
Complications are common within one year after the transplant. These complications
are often caused by the conditioning regimen, delayed immune reconstitution, and GVHD.
Those with complications have higher rates of inpatient readmission to the hospital
in the 12-months following transplantation. The risk and type of complications vary
and are influenced by patient-related factors such as age, performance status, and
comorbidities.
|
TREATMENT
|
The transplant occurs when the healthy hematopoietic stem cells are administered to
the recipient as an intravenous (IV) infusion. Additional IV medications may be provided
immediately before the infusion to prevent complications. The day of
the infusion is considered the date of transplantation.
The post-transplant hospitalization period typically lasts through engraftment, which
usually takes 10-21 days. During this period, treatment generally includes daily blood
count monitoring, antibiotic or antiviral prophylaxis, and use of precautions to avoid
exposure to germs. Supportive and, occasionally, intensive care may be required to
treat complications during the period between conditioning and engraftment.
Because the immune system is severely impaired, the transplant recipient may receive
treatment for complications such as infections or immunodeficiency during the 12 months
after the HSCT. This treatment may include monitoring for potential relapse of the
underlying condition; evaluation and management of chronic GVHD; and evaluation and
treatment of late complications, such as cardiovascular disease, respiratory disease,
frailty, neuropsychiatric disorders, secondary malignancies (new cancers caused by
treatment), and endocrinopathies.
|
SUGGESTED PROGRAMMATIC ASSESSMENT*
|
Suggested MER for Evaluation:
-
•
Report showing history of HSCT within the past 12 months; and
-
•
Diagnostic testing and reports related to the underlying condition that was treated
with HSCT.
|
Suggested Listings for Evaluation:
|
For these listings we generally consider under a disability at least 12
months after the date of transplantation. Any residual impairment(s) that occurs
more than 12 months after the date of transplantation should generally be evaluated
under the affected body system.
|
DETERMINATION
|
LISTINGS
|
REMARKS
|
Meets
|
7.17
13.05 C
13.06 A or B
13.07 B
13.28 A or B
14.07 B
107.17
113.05 C
113.06 A or B
114.07 B
|
Hematological disorders treated with HSCT meet the requirements of listing 7.17.
Cancers treated with allogeneic HSCT meet the requirements of listing 13.28 A.
Cancers treated with autologous HSCT meet the requirements of 13.28 B.
Hematological disorders treated with HSCT meet the requirements of listing 107.17.
|
Equals
|
7.17
107.17
|
Sickle cell disease (SCD) or beta thalassemia treated with one of three approved cell-based
gene therapies (Casgevy, Lyfgenia, or Zynteglo), generally medically equal listing
7.17.
SCD or beta thalassemia treated with one of three approved cell-based gene therapies
(Casgevy, Lyfgenia, or Zynteglo), generally medically equal listing 107.17.
|
* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
|