Practice Guidelines

ASTCT Practice Guidelines 

ASTCT’s practice guidelines include evidence-based reviews, clinical calculators, and position statements from the ASTCT Committee on Practice Guidelines. Each guideline is published in Transplantation and Cellular Therapy and is available as open access.

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Practice Guidline App

Practice guidelines can be accessed on the go via the ASTCT Practice Guideline App. Search  “ASTCT” in your Apple App store or Google Play store to download the app. Click the buttons below to be taken directly to the app.

Mobile app supported by an education grant from Sanofi/US.

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Submit a New Topic Proposal Form

ASTCT Members can submit topics for guideline development or new evidence to support an update of an existing guideline at any time. ASTCT Committee on Practice Guidelines (CoPG) Leadership will review topic proposals on a rolling basis. ASTCT CoPG Leadership will invite approved proposal authors to the next quarterly CoPG call, where the author will present the proposal to CoPG members for questions and considerations. After the call, the CoPG members will then vote to approve or reject the proposal. If you’re interested in submitting a proposal, please complete the form below.

 

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Most Cited Guideline:

ASTCT Consensus Grading for Cytokine Release Syndrome and Neurologic Toxicity Associated with Immune Effector Cells
Published: December 2018

• Cytokine release syndrome (CRS) and neurotoxicity are common after immune effector cell (IEC) therapy.
• Neurotoxicity is now termed IEC-associated neurotoxicity syndrome (ICANS).
• A consensus grading system for CRS and ICANS has been developed by experts in the field.
• The grading system is designed for IEC therapies in clinical trials and commercial use.
• Standardized reporting through the Center for International Blood and Marrow Transplant Research will meet commercial Risk Evaluation and Mitigation Strategies requirements.

Most Recent Guidelines, Position Papers and Surveys

ASTCT and USCLC Clinical Practice Recommendations for Allogeneic Stem Cell Transplant in Mycosis Fungoides and Sézary Syndrome
Published: November 2024

Mycosis fungoides (MF) and Sézary syndrome (SS) are the most common subtypes of cutaneous T-cell lymphoma (CTCL). While MF generally follows an indolent course, a subset of patients will experience progressive and/or treatment-refractory disease; Sézary syndrome is an aggressive lymphoma associated with high morbidity and mortality. Although allogeneic hematopoietic cell transplant (allo-HCT) is the only currently available potentially curative treatment modality for MF/SS there is no published guidance on referral criteria, transplant timing orallo-HCT approach. These clinical practice guidelines provide a framework for decision-making regarding allo-HCT for MF/SS and highlight areas for future prospective investigation.

Best Practice Considerations by The American Society of Transplant and Cellular Therapy: Infection Prevention and Management After Chimeric Antigen Receptor T Cell Therapy for Hematological Malignancies
Published: October 2024

Chimeric antigen receptor (CAR) T-cell therapy is rapidly advancing, offering promising treatments for patients with hematological malignancy. However, associated infectious complications remain a significant concern because of their contribution to patient morbidity and non-relapse mortality. Recent epidemiological insights shed light on risk factors for infections after CAR T-cell therapy. However, the available evidence is predominantly retrospective, highlighting a need for further prospective studies. Institutions are challenged with managing infections after CAR T-cell therapy but variations in the approaches taken underscore the importance of standardizing infection prevention and management protocols across different healthcare settings. Therefore, the Infectious Diseases Special Interest Group of the American Society of Transplantation and Cellular Therapy assembled an expert panel to develop best practice considerations.

Clinical Practice Recommendations for Hematopoietic Cell Transplantation and Cellular Therapies in Follicular Lymphoma: A Collaborative Effort on Behalf of the American Society for Transplantation and Cellular Therapy and the European Society for Blood and Marrow Transplantation
Published: September 2024

Follicular lymphoma (FL) is the most common indolent B-cell non-Hodgkin lymphoma (NHL), accounting for nearly one-third of all NHL. A consensus on the contemporary role, optimal timing, and sequencing of HCT (autologous or allogeneic) and cellular therapies in FL is needed. As a result, the American Society of Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines endorsed this effort to formulate consensus recommendations to address this unmet need. The RAND-modified Delphi method was used to generate 15 consensus statements/recommendations. These clinical practice recommendations will help guide clinicians managing patients with FL. Of note, the use of bispecific antibodies in R/R FL was not in the scope of this project.

Allogeneic Hematopoietic Cell Transplantation for the Treatment of Severe Aplastic Anemia: Evidence-Based Guidelines From the American Society for Transplantation and Cellular Therapy
Published: September 2024

Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for severe aplastic anemia (SAA). Existing guidance about HCT in SAA is primarily derived from expert reviews, registry data and societal guidelines; however, transplant-specific guidelines for SAA are lacking. A panel of SAA experts, both pediatric and adult transplant physicians, developed consensus recommendations using Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) methodology employing a GRADE guideline development tool. These recommendations reflect a significant advancement in transplant strategies for SAA and highlight the importance of ongoing and further research to revisit current evidence in terms of donor choice, conditioning chemotherapy, GVHD prophylaxis and post-transplant immunosuppression.

ASTCT Consensus Recommendations on Testing and Treatment of Patients With Donor-specific Anti-HLA Antibodies
Published: September 2024

Donor-specific anti-HLA antibodies (DSA) are an important cause of engraftment failure and may negatively impact survival outcomes of patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using an HLA-mismatched allograft. This paper aims to standardize current evidence-based practice and formulate future directions to improve upon current knowledge and advance treatment for this relatively rare, but potentially serious complication in allogeneic HSCT recipients.

ASTCT Committee on Practice Guidelines Survey on Evaluation and Management of Relapsed/Refractory Multiple Myeloma After Failure of Chimeric Antigen Receptor T-Cell Therapy
Published: August 2024

The American Society for Transplantation and Cellular Therapy (ASTCT) Committee on Practice Guidelines conducted an online cross-sectional survey between September 2023 and December 2023 to determine myeloma, transplantation, and cellular therapy physicians’ practice patterns for the surveillance, diagnosis, and management of CAR-T failure. The intent of this survey was to understand clinical practice patterns and identify areas for further investigation. Substantial across-center variation in practice patterns raises the need for collaborative studies and expert clinical recommendations to describe best practices for post-CAR-T disease surveillance, optimal workup for treatment failure, and choice of rescue therapies.

Transplantation-Associated Altered Mentation and Encephalopathy: A New Classification for Acute Neurocognitive Changes Associated with Hematopoietic Cell Transplantation from the ASTCT Committee on Practice Guidelines
Published: July 2024

Acute encephalopathy, manifesting clinically as delirium, is a common but often unrecognized complication of hematopoietic cell transplantation (HCT). This manuscript establishes clear diagnostic criteria and discusses factors that can potentially impact the development of transplantation-associated altered mentation and encephalopathy (TAME), as well as the workup and management of TAME.

International Recommendations for Screening and Preventative Practices for Long-Term Survivors of Transplantation and Cellular Therapy: A 2023 Update
Published: April 2024

This review provides updated pediatric and adult survivorship guidelines for HCT and cellular therapy. The contributory role of chronic graft-versus-host disease (cGVHD) to the development of late effects is discussed, but cGVHD management is not covered in detail. These guidelines emphasize the special needs of patients with distinct underlying HCT indications or comorbidities (eg, hemoglobinopathies, older adults) but do not replace more detailed group-, disease-, or condition-specific guidelines. Although these recommendations should be applicable to the vast majority of HCT recipients, resource constraints may limit their implementation in some settings.

Chimeric Antigen Receptor T-Cell Therapy in the Outpatient Setting: An Expert Panel Opinion from the American Society for Transplantation and Cellular Therapy
Published: November 2023

In anticipation of increasing use of CAR-T-cell therapy in the outpatient setting as a mechanism to overcome frequent hospital bed shortages and high cost of inpatient care, ASTCT convened a group of experts in hematology, oncology, and cellular therapy to provide a comprehensive review of the existing publications on outpatient CAR-T cell therapy, discuss selected ongoing clinical trials of outpatient CAR-T and describe strategies to optimize safety without compromising efficacy for patients treated and monitored in the outpatient setting.

American Society of Transplantation and Cellular Therapy Series: #7 - Management of Respiratory Syncytial Virus Infections in Hematopoietic Cell Transplant Recipients
Published September 2023

The Practice Guidelines Committee of ASTCT partnered with its Transplant Infectious Disease Special Interest Group (TID-SIG) to update the 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A new approach was adopted to better serve clinical providers by publishing each standalone topic in the infectious disease series in a concise format of frequently asked questions (FAQ), tables, and figures.

ASTCT Clinical Practice Recommendations for Transplantation and Cellular Therapies in Diffuse Large B Cell Lymphoma
Published: July 2023

Consensus on the contemporary role, optimal timing, and sequencing of HCT and cellular therapies in DLBCL is lacking. Clinical practice recommendations addressing areas of clinical ambiguity not only can aid transplantation and cellular therapy physicians, but also can inform the practice of lymphoma experts and community hematologists who refer these patients to transplantation and cell therapy programs. Therefore, ASTCT undertook this project to formulate consensus recommendations to address this unmet need.

Updated Indications for Immune Effector Cell Therapy: 2023 Guidelines from the American Society for Transplantation and Cellular Therapy
Published, July 2023

ASTCT published its guidelines on indications for autologous and allogeneic hematopoietic cell transplantation (HCT) and immune effector cell therapy (IECT) in 2020. Since then, we have witnessed rapid advancements in the field of IECT, resulting in several new chimeric antigen receptor T cell (CAR-T) products and disease indications being approved by the US Food and Drug Administration (FDA). To keep abreast of these practice changes, the ASTCT Committee on Practice Guidelines commissioned a focused update covering CAR-T therapy indications.

Evaluation of Children with Malignancies for Blood and Marrow Transplantation
Published: February 2023

In this report from the ASTCT Committee on Practice Guidelines, we present a practical framework for evaluating children with malignancies who are candidates for HCT. We also highlight key differences from adults and emphasize areas of unmet need that require additional research to delineate best practices.

ASTCT Series, #6: Management of Invasive Candidiasis in Hematopoietic Cell Transplantation Recipients
Published January 2023

This sixth guideline in the series focuses on invasive candidiasis (IC) with FAQs to address: Epidemiology, Clinical diagnosis, Prophylaxis, Treatment of IC, and special considerations for pediatric, cord blood, haploidentical, and T cell-depleted HCT recipients and chimeric antigen receptor T cell recipients, as well as future research directions.

American Society for Transplantation and Cellular Therapy Return to Work Guidance Committee Recommendations for Health Care Providers Who Take Care of Hematopoietic Cell Transplantation Patients
Published: December 2022

The purpose of the guidance provided herein is to support health care providers of post-HCT recipients, including but not limited to physicians, advanced practice providers (APPs), nurses, nurse navigators, clinical nurse specialists, occupational therapists (OTs), physical therapists (PTs), mental health professionals, and social workers. By providing expert opinion-based guidance rather than guidelines to facilitate communication between providers and patients and between providers and employers, we hope to encourage successful reintegration of this unique population of survivors back into the workplace.

Hematopoietic Cell Transplantation in the Management of Myelodysplastic Syndrome: An Evidence-Based Review
Published: November 2022

In 2009, ASTCT published an initial evidence-based review of allogeneic hematopoietic cell transplantation (HCT) for myelodysplastic syndrome (MDS). The last decade has brought significant advances in the understanding of MDS and its treatment, including revised prognostic tools, novel therapeutic agents, and improved allogeneic HCT practices. The goals of this update were to assemble and critically evaluate new evidence on the role of HCT in the treatment of adult patients with MDS, make treatment recommendations based on the available evidence, and identify areas of need for future research. Pediatric considerations were recently addressed in separate guidelines from the ASTCT.

Hematopoietic Cell Transplantation in the Treatment of Pediatric Acute Myelogenous Leukemia and Myelodysplastic Syndromes
Published: June 2022

As an update to the original practice guideline published in 2007, the goals of this second guidelines report were to critically evaluate all evidence regarding the role of HCT in the treatment of children and adolescents with AML, to revise treatment recommendations where appropriate based on available new evidence, and to identify important areas for future research. We recognize key differences between children and adults, including in the biology of AML and tolerability of conditioning regimens, yet acknowledge where concordance is reasonable around HCT-related care. An updated evidence-based review of adult AML by the ASTCT Committee on Practice Guidelines was published recently. Our recommendations focus on pediatric-specific data but extrapolate from adult studies when appropriate.

Survey on Evaluation & Management of Diffuse Large B-cell Lymphoma after Failure of Chimeric Antigen Receptor T Cell Therapy (CAR-T) Therapy
Published, June 2022

Chimeric antigen receptor T-cell therapy (CAR-T) is a major advance in managing aggressive relapsed or refractory B-cell lymphomas; however, relapses are frequent and pose a major therapeutic challenge. There is substantial variability across transplantation and cellular therapy programs in assessing and managing post-CAR-T failures. The American Society for Transplantation and Cellular Therapy Committee on Practice Guidelines conducted an online cross-sectional survey between August 2021 and October 2021 to determine the U.S. lymphoma and transplantation and cellular therapy physicians’ practice patterns for the detection and diagnosis of CAR-T failure, as well as management strategies for diffuse large B-cell lymphoma in this particular setting.

ASTCT Series: #5—Management of Clostridioides difficile Infection in Hematopoietic Cell Transplant Recipients
Published: February 2022

The Practice Guidelines Committee partnered with its Transplant Infectious Disease Special Interest Group to update its 2009 compendium-style infectious disease guidelines for hematopoietic cell transplantation (HCT). A completely new approach was taken with the goal of better serving clinical providers by publishing each standalone topic in the infectious disease series as a concise format of frequently asked questions (FAQ), tables, and figures.