Immunotherapy--Heme & Lymphoid Neoplasms: Should Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone be coded for myelodysplastic dysplastic syndrome (MDS) and if so, how should it be coded? See Discussion.
Patient failed treatment with Azacitidine for MDS with multilineage dysplasia (9985/3) diagnosed 1/2024, and on re-biopsy of bone marrow 11/2025, histology is now MDS with excess blasts (9989/3). These diagnoses are the same primary using the Hematopoietic and Lymphoid Neoplasms (Heme) Database. The physician has prescribed treatment of Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone. SEER*Rx Database says not to code as ATG and Cyclosporine are antirejection medications post-transplant, but the oncologist is using this combination for treatment.
Code ATG/Cyclosporine as biological response modifier (BRM)/Immunotherapy as first course of treatment using the current Heme Manual. Based on changes to the 2026 Heme rules for coding treatment, heme and lymphoid neoplasms are now treated differently than Solid Tumors when it comes to treatment failure.
It can be used for treatment of selected MDS cases particularly those with low-risk disease, HLA-DR15 histocompatibility type, bone marrow hypoplasia. Prednisone should not be coded as it is not disease modifying agent in MDS. It is usually given to reduce/treat infusion reactions/serum sickness associated with ATG infusion.
Radiation Therapy: Is I 131 sodium iodide coded as radiation? SINQ 20031040 says to code Radiation as 3 (radioisotope) but SEER*Rx says not to code it.
Code sodium iodine (I 131) therapy in Radiation Treatment Modality as code 13 (Radioisotopes, NOS). Code Radiation External Beam Planning Technique as code 88 (not applicable). Do not code if used in diagnostic procedures.
Radioactive I 131 should be coded when given in therapeutic doses (usually 30-50mCi but could be higher in high risk patients). The same agent is used for diagnostic imaging, but the dose is very small (1-3mCi).
First Course Treatment/Heme & Lymphoid Neoplasms--Multiple Myeloma: Is treatment for multiple myeloma coded as first-course treatment until patient achieves remission despite the possibility of progression due to a delay in treatment? A patient with multiple myeloma was advised treatment with Dara-RVD followed by a stem cell transplant. As the patient wanted to take care of another health issue, the patient waited 8 months to start treatment.
Code treatment as first course of treatment, even though there was an 8-month delay. The patient's treatment plan was to delay the cancer treatment due to another health condition. When that health condition was resolved, then the cancer treatment was given. Patients do delay treatment for many different reasons, but most of them would not be 8 months. This fits the new rule which is all treatment is first course until remission.
This is different from active surveillance, where the patient is being monitored for symptoms/disease progression. We have a clarification coming out in the 2027 updates that states if Active Surveillance is the planned treatment until symptoms appear, that any treatment received after active surveillance is second course. That is not the situation here. This is delayed therapy.
First Course Treatment/Other Therapy--Glioblastoma: Is Dendritic Cell/Tumor Cell Electrofusion Cancer Vaccine, coded to Immunotherapy as stated in SEER*Rx? A patient, diagnosed with Glioblastoma (GBM) IDH-wildtype (CNS WHO grade 4), in addition to radiation and chemotherapy, was enrolled on Diakonos/DOC-DBM study, randomized to the vaccine arm. It seems this study evaluates dubodencel, a novel dendritic cell vaccine treating GBM.
Code dubodencel to Other Therapy, code 2 (other-experimental). Dubodencel is not technically Dendritic Cell/Tumor Cell Electrofusion Cancer Vaccine, though close. However, both are in early stages of clinical development. We updated the coding instructions for Dendritic Cell/Tumor Cell Electrofusion Cancer Vaccine in SEER*Rx.
SEER Manual/First Course Treatment/Other Therapy--Breast: How is the agent endoxifen coded when given to treat hormone sensitive breast cancer? This agent is not listed in SEER*Rx.
Code as Other Therapy, code 2 (other-experimental). Endoxifen is currently in phase 2 studies and not FDA approved standard treatment at present.
SEER Manual/First Course Treatment/Other Therapy--Uterus: Is Metformin coded to Other Therapy code 1 vs 6? Multiple GYN physicians have stated, “Adenocarcinoma of Endometrium, treating with intrauterine device and Metformin.” The patient is not on any specified trials.
Code Other Therapy to 6 (Other-Unproven) since Metformin is not included in oncology guidelines and studies show controversial results at this time.
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