cpt 38232, 38240, 38241, 38242, S2140, S2142, S1250

Coding 

Autologous and allogeneic hematopoietic cell transplants are considered investigational to treat advanced stage epithelial ovarian cancer.

Code Description CPT

38232 Bone marrow harvesting for transplantation; autologous

38240 Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor

38241 Hematopoietic progenitor cell (HPC); autologous transplantation

38242 Allogeneic lymphocyte infusions

S2140 Cord blood harvesting for transplantation, allogeneic

S2142 Cord blood-derived stem-cell transplantation, allogeneic

S2150 Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvesting, transplantation, and related complications; including: pheresis and cell preparation/storage; marrow ablative therapy; drugs, supplies, hospitalization with outpatient follow-up; medical/surgical, diagnostic, emergency, and rehabilitative services; and the number of days of pre and post transplant care in the global definition



Hematopoietic Cell Transplantation for Epithelial Ovarian Cancer


Introduction

Hematopoietic stem cells are cells that form within the bone marrow and can become many different types of blood cells. In a hematopoietic stem cell transplant, stem cells can be taken from a donor’s bone marrow, peripheral blood, or from a newborn baby’s umbilical cord blood or placenta shortly after the baby was delivered. The stem cells can also be harvested from the patient herself before she is given any high dose chemotherapy. If the stem cells are harvested from another person, it is called an allogeneic stem cell transplant. If the stem cells come from the patient herself before her high dose chemotherapy is given, it is called an autologous stem cell transplant. 

Hematopoietic stem cell transplants are sometimes given to patients who have epithelial ovarian cancer. These transplants are considered investigational. This policy explains why it is considered to be investigational.

Policy Coverage Criteria 

Condition Investigational  Advanced stage epithelial ovarian cancer




Evidence Review 

Description

Use of hematopoietic cell transplantation (HCT) has been investigated for treatment of patients with epithelial ovarian cancer. Hematopoietic stem cells are infused to restore bone marrow function after cytotoxic doses of chemotherapeutic agents with or without whole body radiotherapy.

Background

Epithelial Ovarian Cancer 

Several types of malignancies can arise in the ovary, and epithelial carcinoma is the most common. Epithelial ovarian cancer is the fifth most common cause of cancer death in women. For 2016, new cases and deaths from ovarian cancer in the United States were estimated at 22,280 and 14,240, respectively.

Most ovarian cancer patients present with widespread disease, and the National Cancer Institute Surveillance, Epidemiology and Results Program reported a 46.5% five-year survival for all cases between 2007 and 2013.

Treatment

Current management for advanced epithelial ovarian cancer is cytoreductive surgery with chemotherapy.

Approximately 75% of patients present with International Federation of Gynecology and Obstetrics stage III to IV ovarian cancer and are treated with paclitaxel plus a platinum analogue, the preferred regimen for the newly diagnosed advanced disease. Use of platinum and taxanes has improved progression-free survival and overall survival in advanced disease to between 16 and 21 months and 32 and 57 months, respectively.

However, cancer recurs in most women, and they die of the disease because chemotherapy drug resistance leads to uncontrolled cancer growth.


Hematopoietic Cell Transplantation

Hematopoietic cell transplantation (HCT) is a procedure in which hematopoietic stem cells are infused to restore bone marrow function in cancer patients who receive bone-marrow-toxic doses of drugs with or without whole body radiotherapy. Bone marrow stem cells may be obtained from the transplant recipient (autologous HCT) or from a donor (allogeneic HCT). They can be harvested from bone marrow, peripheral blood, or umbilical cord blood and placenta shortly after delivery of neonates. Although cord blood is an allogeneic source, the stem cells in it are antigenically “naive” and thus are associated with a lower incidence of rejection or graftversus-host disease. Cord blood is discussed in greater detail in a separate medical policy (see Related Policies).
HCT is an established treatment for certain hematologic malignancies; however, its use in solid tumors in adults is largely experimental. 

HCT for Epithelial Ovarian Cancer 

HCT has been investigated as a therapy to overcome drug resistance. However, limited data exist on this treatment approach, and the ideal patient population and best treatment regimen remain to be established.

 HCT has been tested in various patient groups with ovarian cancer: 
* To consolidate remission after induction therapy
* To treat relapse after a durable response to platinum-based chemotherapy
* To treat tumors that relapse after less than 6 months
* To treat refractory tumors