Consequently, there has been a temporary reduction in HCT rates in some indications, with necessary prioritisation between indications and delays in treatment that may have impacted upon outcomes of HCT. The EBMT regularly updates recommendations for SARS-COv-2 management and vaccination ( ). From an early stage, there was recognition that outcomes following HCT and CAR-T cell therapies were poorer in patients in whom SARS-2-CoV infection was detected and also a response to vaccination is reduced and variable in the HCT setting. Waves of the pandemic impacted variably across our geographical regions, requiring broader public health measures, including the uptake of vaccination. Since the last update, we have experienced the Coronavirus disease-19 (COVID-19) pandemic, which has affected HCT activity for a variety of reasons, from risks to patients, availability of donors and stem cell products, through to maintenance of staffing and services. The recommendations are not intended to be used to choose a particular transplant protocol, conditioning regimen or stem cell source, but we encourage harmonisation of practice, where possible, to ensure meaningfully aggregated experience across indications via registry outputs. Besides potential survival benefits, assessment must include quality of life and late effects. They must be considered in conjunction with the risk of the disease status, the likelihood of the successful outcome of HCT, assessment of patient co-morbidities and estimation of treatment-related mortality (TRM) risk alongside the results of non-transplant strategies. They aim to provide general guidance on transplant indications to inform individual patient decisions by the multidisciplinary team (MDT). As in previous editions, these 2022 recommendations are based upon clinical trials, registry data, and the opinion of EBMT experts from the board, scientific council and relevant working parties, but not upon a formal extensive or systematic review of the literature. For over two decades, EBMT has considered changes in HCT practice alongside developments in non-transplant treatments. This is the eighth report from the European Society for Blood and Marrow Transplantation (EBMT) covering indications for haematopoietic cell transplantation (HCT) according to prevailing clinical practice in EBMT countries and centres. Although the full impact of the pandemic is yet to be determined, we recommend that decision making across indications is delivered with ongoing reference to EBMT and national COVID-19 guidance, in accordance with current local conditions. Since the last edition, the COVID-19 pandemic has affected clinical decision making and activity across indications. We also recommend working according to JACIE accreditation standards to maintain quality in clinical and laboratory components of practice, including benchmarking of survival outcomes. HCT techniques are constantly evolving and we make no specific recommendations, but encourage harmonisation of practice, where possible, to ensure experience across indications can be meaningfully aggregated via registry outputs. In order to inform patient decisions, these recommendations must be considered in conjunction with the risk of the disease, risk of HCT procedure and non-transplant strategies, including evolving cellular therapies. Our aim is to provide general guidance on HCT indications according to prevailing clinical practice in EBMT countries and centres. This is the eighth special EBMT report on the indications for HCT for haematological diseases, solid tumours and immune disorders.
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