Clinical Scorecard: Current Guidelines for Hematopoietic Cell Transplantation in Hematological Disorders, Solid Tumors, and Immune Conditions: A 2022 Overview from Europe

At a Glance

Key Highlights

• EBMT 2022 guidelines provide general guidance on HCT indications based on clinical trials, registry data, and expert opinion without a formal systematic literature review.
• Donor selection includes matched sibling donors, matched unrelated donors, mismatched unrelated donors, and haploidentical donors with evolving evidence supporting comparable outcomes among these categories.
• COVID-19 pandemic impacted HCT activity, necessitating prioritization and MDT decision-making with reference to evolving EBMT and national COVID-19 guidance.

Guideline-Based Recommendations

Diagnosis

• Assess disease status, patient comorbidities, and treatment-related mortality risk before HCT.
• Consider non-transplant treatment options alongside HCT indications.
• Use EBMT classification categories to guide transplant indication decisions.

Management

• Select donor type based on HLA matching and availability, including MSD, MUD, MMUD, and haploidentical donors.
• Incorporate graft-versus-host disease prophylaxis strategies such as post-transplant cyclophosphamide for haploidentical transplants.
• Decisions should be individualized and made by a multidisciplinary team considering local expertise, patient and donor preferences, and resource availability.

Monitoring & Follow-up

• Monitor for transplant-related mortality, graft-versus-host disease, and quality of life outcomes.
• Adapt management according to evolving evidence and registry data.
• Follow EBMT COVID-19 recommendations for infection prevention and vaccination in HCT recipients.

Risks

• Consider risks of treatment-related mortality and late effects post-transplant.
• Recognize increased risks related to SARS-CoV-2 infection and reduced vaccine response in HCT recipients.
• Balance risks of delayed transplantation against disease progression, especially during pandemic conditions.

Patient & Prescribing Data

Patients undergoing hematopoietic cell transplantation for hematological malignancies, inherited diseases, immune conditions, and selected solid tumors

HCT indications and donor selection should be tailored by MDTs; emerging evidence supports use of haploidentical and mismatched donors with appropriate prophylaxis; COVID-19 impacts require dynamic treatment prioritization and infection management.

Clinical Best Practices

• Use multidisciplinary team meetings to integrate clinical evidence, patient factors, and local resources in transplant decision-making.
• Harmonize transplant practices across centers to enable meaningful registry data aggregation and outcome comparisons.
• Incorporate up-to-date EBMT and national guidelines on COVID-19 management and vaccination for transplant recipients.
• Apply flexible age definitions for pediatric, TYA, and adult transplant indications to optimize patient care.
• Document all transplant decisions comprehensively to support transparency and quality assurance.

References

• EBMT COVID-19 and BMT Recommendations