Clinical Report: 2022 EBMT Guidelines for Hematopoietic Cell Transplantation

Overview

The 2022 European Society for Blood and Marrow Transplantation (EBMT) guidelines provide updated recommendations on hematopoietic cell transplantation (HCT) indications across hematological disorders, solid tumors, and immune conditions. These guidelines incorporate recent advances, including donor selection, transplant modalities, and the impact of the COVID-19 pandemic on HCT practices.

Background

Hematopoietic cell transplantation (HCT) is a critical therapeutic option for various hematological malignancies, inherited diseases, and immune conditions. The EBMT has issued periodic guidance for over two decades, reflecting evolving clinical evidence and practice. The 2022 update integrates registry data, clinical trials, and expert opinion to guide multidisciplinary teams in patient selection and transplant decision-making. The guidelines emphasize balancing transplant benefits against risks such as treatment-related mortality, quality of life, and late effects, while also considering non-transplant therapies.

Data Highlights

The 2022 EBMT report highlights that acute myeloid leukemia (AML) accounts for over one-third of allogeneic HCT procedures. Donor types are categorized as matched sibling donors (MSD), matched unrelated donors (MUD, 10/10 HLA match), mismatched unrelated donors (MMUD), haploidentical donors, and cord blood. Recent data show comparable outcomes between MSD, MUD, and haploidentical transplants using post-transplant cyclophosphamide (PTCy). The COVID-19 pandemic caused temporary reductions and prioritization in HCT activity, with ongoing updates on SARS-CoV-2 management and vaccination in transplant recipients.

Key Findings

• HCT indications are classified into four categories based on evidence and recommendation strength.
• Donor selection includes autologous, syngeneic, and allogeneic sources, with allogeneic donors further subdivided by HLA matching.
• Non–T-cell-depleted haploidentical HCT with PTCy reduces chronic GVHD and treatment-related mortality, showing outcomes comparable to matched sibling and unrelated donors.
• The COVID-19 pandemic impacted HCT activity, necessitating prioritization and adaptation of transplant timing and protocols.
• CAR-T cell therapies are referenced as emerging options alongside HCT in select hematological malignancies such as ALL and lymphomas.
• Age group definitions (pediatric, teenager and young adult, adult) are flexible, especially for inherited diseases and transplant indications overlapping these groups.

Clinical Implications

Clinicians should integrate EBMT 2022 recommendations with local expertise and patient-specific factors in multidisciplinary team discussions to optimize transplant timing and donor selection. Awareness of evolving donor options, including haploidentical transplantation with PTCy, expands access to HCT. The ongoing impact of COVID-19 requires adherence to updated infection control and vaccination guidelines to mitigate risks in transplant recipients.

Conclusion

The 2022 EBMT guidelines provide a comprehensive framework for HCT indications, donor selection, and transplant strategies, reflecting recent advances and pandemic-related challenges. These recommendations support harmonized clinical decision-making to improve patient outcomes across hematological and immune disorders.

References

1. EBMT 2022 -- Current Guidelines for Hematopoietic Cell Transplantation in Hematological Disorders, Solid Tumors, and Immune Conditions