Table 1 Proposed classification of transplant indications for adults—2025.

From: Indications for haematopoietic cell transplantation and CAR-T for haematological diseases, solid tumours and immune disorders: 2025 EBMT practice recommendations

Disease	Disease status	MSD allo	MUD allo	MMAD allo	Auto	CAR-T
*Haematological Malignancies*
AML^{a^}	CR1 (favourable risk and MRD–)^b	GNR/II	GNR/II	GNR/II	CO/I
	CR1 (favourable risk and MRD+)^b	S/II	CO/II	CO/II	GNR/II
	CR1 (intermediate risk)^b	S/II	CO/II	CO/II	CO/I
	CR1 (adverse risk)^b	S/II	S/II	S/II	GNR/I
	CR2	S/II	S/II	S/II	CO/II
	APL Molecular CR2	S/II	CO/II	GNR/III	S/II
	Relapse or refractory	CO/II	CO/II	CO/II	GNR/III
ALL^a	Ph (–), CR1 (standard risk and MRD–)^b	GNR/II	GNR/II	GNR/III	CO/III
	Ph (–), CR1 (standard risk and MRD+)^b	S/II	CO/II	CO/II	GNR/II	CO/II
	Ph (–), CR1 (high risk)^b	S/II	S/II	CO/II	GNR/III
	Ph (+), CR1 (MRD–)	S/II	S/II	CO/II	CO/III
	Ph (+), CR1 (MRD+)	S/II	S/II	S/II	GNR/II
	CR2	S/II	S/II	S/II	GNR/II
	Relapse or refractory	CO/II	CO/II	CO/II	GNR/III
CML	CP1, failing ≥ 3 TKI	S/II	S/II	CO/II	GNR/II
CML	Advanced Phase, BP-CML or >CP1	S/II	S/II	S/II	GNR/III
Myelofibrosis (MF)	Primary MF with an intermediate-2 or high-risk DIPSS or high-risk MIPSS70/MIPSS70-plus score. Secondary MF with an intermediate-2 or high risk MYSEC-PM score [88]	S/II	S/II	S/III	GNR/III
MDS	Very low and low-risk (IPSS-R or IPSS-M)	GNR/II	GNR/II	GNR/II	GNR/III
	Intermediate-risk without additional factors^c (IPSS-R) or moderate-low (IPSS-M)	D/II	D/II	D/II	CO/II
	Intermediate-risk (IPSS-R) or moderate low (IPSS-M) with additional factors^c	S/II	S/II	S/II	GNR/III
	High-, very high-risk (IPSS-R) or moderate-high, high or very high-risk (IPSS-M)	S/II	S/II	S/II
	sAML in CR1 or CR2	S/II	S/II
CMML	CPSS-Mol High	S/II	S/II	S/II	GNR/III
CMML	CPSS-Mol Intermediate-2 with one additional risk factor^d	S/II	S/II	S/II	GNR/III
CLL	Poor risk disease refractory or relapsing after treatment with BTKi- and BCL2 inhibitor-based regimens (Richter’s transformation excluded)	CO/II	CO/II	CO/III	GNR/III	CO/II
CLL	Richter transformation (clonally related)	S/II	S/II	S/II	GNR/III	CO/II
LBCL	CR1 (intermediate/high IPI at diagnosis)	GNR/III	GNR/III	GNR/III	CO/II	D/II
	Primary refractory disease	GNR/III	GNR/III	GNR/III	GNR/III	S/I
	Early relapse with untested or chemoresistant disease	GNR/III	GNR/III	GNR/III	GNR/I	S/I
	Early chemosensitive relapse ≥CR2	GNR/III	GNR/III	GNR/III	CO/II	S/I
	Late relapse ≥CR2	GNR/III	GNR/III	GNR/III	S/II	CO/II
	Relapse or progressive disease after CAR-T	CO/II	CO/II	CO/II	GNR/III	GNR/III
	Relapse after auto-HCT	CO/II	CO/II	CO/II	GNR/III	S/II
	Primary CNS lymphoma, first-line therapy	GNR/III	GNR/III	GNR/III	S/II	GNR/III
	Primary CNS lymphoma, relapse and progressive disease	GNR/III	GNR/III	GNR/III	CO/II	CO/II
FL	First line, untransformed	GNR/III	GNR/III	GNR/III	GNR/II	GNR/III
	First line chemosensitive, transformed	GNR/III	GNR/III	GNR/III	CO/III	GNR/II
	Chemosensitive relapse ≥2nd line, POD24	CO/III	CO/III	GNR/III	S/II	D/III
	Chemosensitive relapse ≥3rd line, after auto-HCT failure	S/II	S/II	CO/II	GNR/III	S/II
	Refractory relapse	GNR/III	GNR/III	GNR/III	GNR/III	S/II
	After CAR-T failure	CO/II	CO/II	CO/III	GNR/III	D/II
MCL	CR1	GNR/III	GNR/III	GNR/III	S/I	D/III
	CR/PR > 1, no prior BTKi	CO/III	CO/III	D/III	CO/II	D/III
	CR/PR 2, after 1st-line BTKi	CO/III	CO/III	D/III	D/III	CO/III
	CR/PR > 2, after prior BTKi	CO/II	CO/II	CO/III	GNR/II	S/II
	Refractory	CO/II	CO/II	CO/III	GNR/II	S/II
WM	CR1	GNR/III	GNR/III	GNR/III	GNR/III	GNR/III
	Chemosensitive relapse, ≥CR2	GNR/III	GNR/III	GNR/III	CO/II	GNR/III
	Poor risk, multiply relapse, refractory disease	CO/II	CO/II	D/III	CO/II	GNR/III
PTCL	CR1				CO/II	GNR/III
	Chemosensitive relapse, ≥CR2/PR2	S/II	S/II	CO/III*	CO/II	GNR/III
	Refractory	CO/II	CO/II	CO/III	GNR/II	GNR/III
Primary CTCL	EORTC/ISCL Stages I–IIA (early)	GNR/III	GNR/III	GNR/III	GNR/III	GNR/III
Primary CTCL	EORTC/ISCL Stages IIB–IV (advanced)	CO/III	CO/III	D/III**	GNR/III	GNR/III
HL	CR1	GNR/III	GNR/III	GNR/III	GNR/I	GNR/III
	Chemosensitive relapse, no prior auto-HCT	D/III	D/III	GNR/III	S/I	GNR/III
	Chemosensitive relapse, after prior auto-HCT	S/II	S/II	S/II	CO/III	GNR/III
	Refractory	D/II	D/II	D/III	CO/III	GNR/III
MM	Upfront standard risk	CO/II	CO/II	GNR/III	S/I
	Upfront high risk	CO/III	CO/III	GNR/II	S/I
	Chemosensitive relapse, prior auto-HCT	CO/II	CO/II	CO/II	S/II	GNR/III
	Refractory/relapse after three lines of prior therapy, including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38					S/II
AL		GNR/III	GNR/III	GNR/III	CO/II
*Other Diseases*
Acquired SAA^# (+/- asymptomatic PNH clone)	Newly diagnosed	S/II	CO/III	GNR/III***	NA
Acquired SAA^# (+/- asymptomatic PNH clone)	Relapsed/refractory	S/II	S/II	CO/II***	NA
PNH	Classical (haemolysis, ±thrombosis)	GNR/II	GNR/II	GNR/II****	NA
PNH	AA/PNH syndrome (severe cytopenia)	CO/II	CO/II	CO/III****	NA
Constitutional BMF syndromes/SAA^e		S/II	S/II	CO/II*****	NA
Breast Cancer	Adjuvant high risk, selected population	NA	NA	NA	D/CO/I	NA
Breast Cancer	Metastatic	GNR/II	NA	NA	CO/I	D
Germ cell tumours	Second line, high risk	NA	NA	NA	CO/II	NA
	Primary refractory, second and further relapse	NA	NA	NA	S/II	D/II
	First line mediastinal non seminoma	NA	NA	NA	CO/II	D
Ovarian Carcinoma	High risk/recurrent	GNR/II	NA	NA	GNR/I	D/II
Medulloblastoma	Post-surgery, high risk/recurrent disease	NA	NA	NA	CO/III	D/II
Gliomas	Recurrent disease	NA	NA	NA	GNR	D/II
Small cell lung Cancer	Limited	NA	NA	NA	GNR/I	NA
Soft tissue Sarcoma/ Bone sarcoma	Advanced	GNR/III	NA	NA	GNR/D/II	D/II
Ewing Sarcoma	Locally advanced/metastatic	GNR/III	NA	NA	CO/II	D
Renal cell Carcinoma	Refractory to conventional treatments	GNR/II	NA	NA	NA	D
Colorectal Ca, Pancreatic Ca, other selected solid tumours	Refractory to conventional treatments	GNR/III	NA	NA	NA	D/II
Multiple sclerosis	Highly active RR-MS failing DMT	D/III	GNR/III	GNR/III	S/I	D/II
	Progressive MS with AIC, and Aggressive MS^f	D/III	GNR/III	GNR/III	CO/II	D/II
	Progressive MS without AIC	GNR/III	GNR/III	GNR/III	GNR/III	D/II
Systemic sclerosis		D/III	GNR/III	GNR/III	S/I	D/II
SLE		D/III	GNR/III	GNR/III	CO/II	D/II
Crohn’s disease		D/III	D/III	D/III	CO/II
Rheumatoid arthritis		D/III	GNR/III	GNR/III	CO/II	D/II
JIA		CO/II	CO/II	CO/III	CO/II
Monogenic AD		CO/II	CO/II	CO/III	GNR/II
Vasculitis	ANCA+ve, BD, Takayasu, others	GNR/III	GNR/III	GNR/III	CO/II
Idiopathic inflammatory myopathy		GNR/III	GNR/III	GNR/III	CO/II	D/II
Autoimmune cytopenias		CO/II	CO/II	CO/III	CO/II
Neuromyelitis optica		D/III	D/III	D/III	CO/II	D/II
CIDP, MG and SPS		GNR/III	GNR/III	GNR/III	CO/II	D/II
Type 1 diabetes		GNR/III	GNR/III	GNR/III	D/II
RCD type II		GNR/III	GNR/III	GNR/III	CO/II
Primary ID		CO/II	CO/II	CO/II	NA
IEM		CO/III	CO/III	CO/III	NA
TDT	Absence of iron severe tissue/organ damage	CO/II	CO/II	D/II^##	NA
SCD	Severe clinical disease and absence of severe organ/tissue damage	S/II	D/II	CO/II^##	NA

This classification does not cover patients for whom a syngeneic donor is available.
AA aplastic anaemia, AD autoimmune disorders, AIC active inflammatory component, AL amyloidosis, ALL acute lymphoblastic leukaemia, Allo allogeneic transplantation, AML acute myeloid leukaemia, APL acute promyelocytic leukaemia, Auto autologous transplantation, BF-CML blast phase CML, BMF bone marrow failure, BTKi Bruton’s tyrosine kinase inhibitor, Ca cancer or carcinoma, CAR-T chimeric antigen receptor T cells, CIDP chronic inflammatory demyelinating polyneuropathy, CLL chronic lymphocytic leukaemia, CML chronic myelogenous leukaemia, CMML chronic myelomonocytic leukaemia, CO clinical option (can be carried after careful assessment of risks and benefits), CP chronic phase, CPSS CMML-specific Prognostic Scoring System, CR1, 2, 3 first, second, third complete remission, CTCL cutaneous T-cell lymphoma, D developmental (further trials are needed), DIPSS dynamic international prognostic score system, DMT disease-modifying treatments, FL follicular lymphoma, GNR generally not recommended, HL Hodgkin lymphoma, HCT haematopoietic cell transplantation, IEM inborn error of metabolism, ID immunodeficiency, IPI international prognostic index, IPSS-R revised International Scoring System, JIA juvenile idiopathic arthritis, LBCL large B-cell lymphoma, MCL mantle cell lymphoma, MDS myelodysplastic syndromes, MG myasthenia gravis, MIPSS70 or MIPSS70-plus Mutation-Enhanced International Prognostic Score Systems, MM multiple myeloma, MMAD mismatched alternative donors (cord blood, haploidentical and mismatched unrelated donors), MP-CMML myeloproliferative CMML, MRD measurable residual disease, MS multiple sclerosis, MSD matched sibling donor, MUD well-matched unrelated donor (8/8, 10/10, or 9/10 if mismatched is in DQB1), MYSEC-PM for secondary MF, NA not applicable, PM-DM polymyositis-dermatomyositis, PNH paroxysmal nocturnal haemoglobinuria, PR partial remission, PTCL Peripheral T-cell lymphomas, RA refractory anaemia, RAEB refractory anaemia with excess blasts, RCD refractory coeliac disease, RCMD refractory cytopenia with multilineage dysplasia, RR-MS relapsing-remitting multiple sclerosis, S standard of care (generally indicated in suitable patients), Sa sarcoma, SAA severe aplastic anaemia, sAML secondary acute myeloid leukaemia, SCD sickle cell disease, SLE systemic lupus erythematosus, SPS stiff person syndrome, TCL T-cell lymphoma, TDT Transfusion dependent Thalassaemia, TKI tyrosine kinase inhibitors, WM Waldenström macroglobulinemia.
^Haploidentical allo-HCT for secondary AML: S/II.
*Haploidentical allo-HCT for PTCL and primary CTCL: S/II for chemosensitive relapse, ≥CR2/PR2.
**Haploidentical allo-HCT for primary CTCL: CO for Refractory and EORTC/ISCL Stages IIB–IV (advanced).
***Haploidentical allo-HCT for Acquired SAA (±asymptomatic PNH clone): Newly diagnosed: D/III and Relapsed/refractory: CO/III.
**** Haploidentical allo-HCT for PNH Classical (haemolysis, ±thrombosis): GNR/II and AA/PNH syndrome (severe cytopenia): CO/III.
***** Haploidentical allo-HCT for Constitutional BMF syndromes/SAA: CO/III.
# Here adult patients are defined as aged up to 40–50 years old; in patients >50 yo, allo-HCT should always be considered at the best as CO, even in refractory/relapsed patients.
## For thalassaemia and SCD, MMAD indication applies ONLY to haploidentical allo-HCT.
^aTransplant indications, maintenance therapy after transplant is being increasingly used with the aim of improving survival outcomes (e.g. FLT3 inhibitors in FLT3-ITD AML or TKI in Ph+ALL).
^bCategories are based on number of white blood cells, cytogenetics and molecular markers at diagnosis and time to achieve remission (see text).
^cAdditional factors include >5% marrow blasts, poor karyotype, profound cytopenias (i.e. Hb <80 g/L, ANC < 0.8 × 10⁹/L, platelets <50 × 10⁹/L), or severe BM
fibrosis.
^de.g. extramedullary involvement, significant B symptoms, (hyper)leukocytosis, iron overload, red blood cell transfusion dependence (≥2 per month), platelet transfusion dependence (≥1 per week) splenomegaly, PB or BM blasts ≥10%, as well as adverse cytogenetics and/or gene mutations e.g. TP53.
^eConstitutional SAA includes Fanconi anaemia, dyskeratosis congenita, Blackfan–Diamond anaemia and other inborn bone marrow failure syndromes (see also the section and table for paediatric indications).
^fAggressive MS as per Menon et al. Menon S, Shirani A, Zhao Y, et al. Characterising aggressive multiple sclerosis. J Neurol Neurosurg Psychiatry. 2013;84:1192–8.

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Table 1 Proposed classification of transplant indications for adults—2025.

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