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Below you will be able read over the summaries of three consensus recommendations papers including the 7th edition of the EBMT Indications Manuscript; donor selection in haploidentical HCT; maintenance therapies for Hodgkin and Non-Hodgkin Lymphomas after Autologous Transplantation.

Indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders: current practice in Europe, 2019.

Rafael F. Duarte, Myriam Labopin, Peter Bader, Grzegorz W. Basak, Chiara Bonini, Christian Chabannon, Selim Corbacioglu, Peter Dreger, Carlo Dufour, Andrew R. Gennery, Jürgen Kuball, Arjan C. Lankester, Francesco Lanza, Silvia Montoto, Arnon Nagler, Régis Peffault de Latour, John A. Snowden, Jan Styczynski, Ibrahim Yakoub-Agha, Nicolaus Kröger, Mohamad Mohty, for the European Society for Blood and Marrow Transplantation (EBMT).

Bone Marrow Transplantation 2019 Apr 5. doi: 10.1038/s41409-019-0516-2. [Epub ahead of print]

This is the seventh special EBMT report on the indications for haematopoietic stem cell transplantation for haematological diseases, solid tumours and immune disorders. The aim of this manuscript is to provide general guidance on transplant indications according to prevailing clinical practice in EBMT countries and centres, and its relevance comes from international recognition and adoption by many societies and authorities in this field. Nevertheless, these recommendations must be considered together with the risk of the disease, the risk of the transplant procedure and the results of non-transplant strategies in order to inform patient decisions. As in previous editions, the new indications have incorporated changes in transplant practice coming from scientific and technical developments in the field. A major such new development is the arrival of CAR-T cells, which may turn in a true revolution for the management of some haematological malignancies. EBMT, along with other societies and professional groups, is making efforts to deliver a roadmap to implement CAR-T programs that overcome potential limitations, secure good assessment and prediction of efficacy, manage toxicities for safe early delivery and long-term monitoring, as well as discuss with key stakeholders in order to improve accessibility and sustainability for healthcare programs. However, this report does not yet provide specific recommendations about the use of CAR-T cells, as additional experience will be needed with these new cellular therapies to decide on their optimal use, overall and with regards to their positioning in relation to the current standard of care of HSCT. In addition, this updated report includes an additional set of data with overall survival at one year and non-relapse mortality at day 100 after transplant in the commonest standard-of-care indications. Additional efforts are currently underway to enable EBMT member centres to benchmark their risk-adapted outcomes as part of Project 2020, alongside the MACRO registry.

 

The European Society for Blood and Marrow Transplantation (EBMT) consensus recommendations for donor selection in haploidentical hematopoietic cell transplantation.

Ciurea SO, Al Malki MM, Kongtim P, Fuchs EJ, Luznik L, Huang XJ, Ciceri F, Locatelli F, Aversa F, Castagna L, Bacigalupo A, Martelli M, Blaise D, Ben Soussan P, Arnault Y, Handgretinger R, Roy DC, O'Donnell PV, Bashey A, Solomon S, Romee R, Gayoso J, Lazarus HM, Ballen K, Savani BN, Mohty M, Nagler A.

Bone Marrow Transplantation 2019 Mar 4. doi: 10.1038/s41409-019-0499-z. [Epub ahead of print]

As the number of HLA-haploidentical hematopoietic cell transplants continues to increase worldwide, and in view of the encouraging results in recent years, an important question remains in many cases for whom the selection of the best potential donor among multiple HLA-haploidentical donors available remains a challenge. This important manuscript presents EBMT consensus recommendations in collaboration with a broad international group of experts. These recommendations provide a comprehensive review and description of the evidence available on the various approaches currently used for haploidentical transplantation and on the impact on outcome of donor variables such as presence of donor-specific antibodies in the recipient, donor age, donor/recipient gender and ABO combinations, and immunogenic variables, such as natural killer cell alloreactivity or KIR haplotype. Thus, this EBMT report is of great relevance to inform the community of consensus recommendations to select haploidentical donors for patients undergoing T-cell replete and T-cell depleted haploidentical transplants.

 

Maintenance Therapies for Hodgkin and Non-Hodgkin Lymphomas After Autologous Transplantation: A Consensus Project of ASBMT, CIBMTR, and the Lymphoma Working Party of EBMT.

Kanate AS, Kumar A, Dreger P, Dreyling M, Le Gouill S, Corradini P, Bredeson C, Fenske TS, Smith SM, Sureda A, Moskowitz A, Friedberg JW, Inwards DJ, Herrera AF, Kharfan-Dabaja MA, Reddy N, Montoto S, Robinson SP, Abutalib SA, Gisselbre C, Vose J, Gopal A, Shadman M, Perales MA, Carpenter P, Savani BN, Hamadani M.

JAMA Oncology 2019 Feb 28. doi: 10.1001/jamaoncol.2018.6278. [Epub ahead of print]

The evolving therapeutic landscape for patients with lymphoma brings together autologous transplantation with the potential use of novel drugs as maintenance to reduce the risk of disease relapse. However, evidence relevant to contemporary practice in this setting remains limited. To fill this gap, ASTCT, CIBMTR and EBMT jointly convened an expert panel with diverse expertise and geographical representation to formulate consensus recommendations presented in this manuscript on the use of maintenance and/or consolidation therapies after autologous transplantation in patients with lymphoma. Following RAND-modified Delphi methodology, the panel a total of 22 consensus statements regarding post-autologous transplantation maintenance and/or consolidation therapies, including the following grade A recommendations: (1) brentuximab vedotin (BV) maintenance and/or consolidation in BV-naïve high-risk HL, (2) rituximab maintenance in MCL undergoing autologous transplant after first-line therapy, (3) rituximab maintenance in rituximab-naïve FL, and (4) No post-autologous transplant maintenance was recommended in DLBCL. In the absence of contemporary evidence-based data, these consensus recommendations are of great relevance for clinical practice in real-world clinical scenarios where randomized data are lacking.

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