Hematopoietic Stem-Cell Transplantation for Malignant Astrocytomas and Gliomas
DESCRIPTION
Hematopoietic stem-cell transplantation (HSCT) refers to a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer individuals who receive bone marrow-toxic doses of cytotoxic drugs with or without whole-body radiation. Autologous stem cell transplantation refers to the harvesting of stem cells from the transplant recipient and administering the cells to the same individual.
Astrocytomas are a type of brain cancer that originates from star-shaped brain cells in the cerebrum called astrocytes. Gliomas or glioblastomas are malignant tumors of the glial tissue of the nervous system. They are sometimes called anaplastic astrocytomas, glioblastoma multiforme, or oligodendroglioma. These tumors are classified histologically into 3 grades of malignancy: Grade II astrocytoma, grade III anaplastic astrocytoma, and grade IV glioblastoma multiform. Glioblastoma multiforme is the most malignant stage of astrocytoma. Oligodendrogliomas are diffuse neoplasms that are clinically and biologically most closely related to diffuse fibrillary astrocytomas.
Treatment of primary brain tumors focuses on surgery, either with curative intent or optimal tumor debulking. Surgery may be followed by radiation therapy and/or chemotherapy.
POLICY
Autologous hematopoietic stem cell transplantation for the treatment of malignant astrocytomas and gliomas (e.g., glioblastoma multiforme and oligodendroglioma) is considered investigational.
IMPORTANT REMINDERS
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We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the medical policy and a health plan or government program (e.g., TennCare), the express terms of the health plan or government program will govern.
SOURCES
American Cancer Society. (2020). Treating brain and spinal cord tumors in adults. Retrieved June 3, 2020 from www.cancer.org.
American Cancer Society. (2020). Treating brain and spinal cord tumors in children. Retrieved June 3, 2020 from www.cancer.org.
Centers for Medicare & Medicaid Services. CMS.gov. National Coverage Determination (NCD) for stem cell transplantation (110.23). Retrieved August 7, 2018 from http://www.cms.gov.
Egan, G., Cervone, K., Philips, P., Belasco, J., Finlay, J., & Gardner, S. (2016). Phase I study of temozolomide in combination with thiotepa and carboplatin with autologous hematopoietic cell rescue in patients with malignant brain tumors with minimal residual disease. Bone Marrow Transplantation, 51 (4), 542-545. Abstract retrieved August 2, 2017 from PubMed database.
Lee, J., Lim, D., Sung, K., Lee, H., Yi, E., Yoo, K., et al. (2017). Tandem high-dose chemotherapy and autologous stem cell transplantation for high-grade gliomas in children and adolescents. Journal of Korean Medical Science, 32 (2), 195-203. (Level 4 evidence)
National Cancer Institute. (2022, May). Childhood astrocytomas treatment (PDQ®). Retrieved August 11, 2023 from www.cancer.gov.
National Cancer Institute. (2023). Adult central nervous system tumors treatment (PDQ®). Retrieved August 11, 2023 from www.cancer.gov.
National Comprehensive Cancer Network. (2023, March). NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Central nervous system cancers, V1.2023. Retrieved August 11, 2023 from the National Comprehensive Cancer Network.
ORIGINAL EFFECTIVE DATE: 4/14/2011
MOST RECENT REVIEW DATE: 10/12/2023
ID_BT
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