is considered medically necessary for members meeting the following criteria:
patient with diagnosis of high-risk Neuroblastoma who have achieved partial
response to prior first-line multi-agent, multi-modality therapy (i.e.
induction combination chemotherapy, myeloblative consolidation chemotherapy
followed by autologous stem cell transplant, and radiation therapy) AND
Being used in
combination with GM-CSF, interleukin-2, and 13-cis-retinoic acid
considered experimental and investigational for all other uses