Table 2 Proposed classification of transplant indications for children and adolescents—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 and subtypes	MSD allo	MUD allo	MMAD allo	Auto	CAR-T
*Haematological malignancies*
AML	CR1 (low risk)^a	GNR/II	GNR/II	GNR/III	GNR/II
	CR1 (high and very high risk)^a	S/II	S/II	CO/II	GNR/II
	CR2	S/II	S/II	S/II	GNR/II
	>CR2	S/II	CO/II	CO/II	GNR/II
ALL	CR1 (low risk)^a	GNR/II	GNR/II	GNR/III	GNR/II	GNR
	CR1 (high risk)^a	S/II	S/II	CO/II	GNR/II	CO/II (refractory pB-ALL)
	CR2	S/II	S/II	CO/II	GNR/II	CO/II (refractory pB-ALL or relapse post-HCT)
	>CR2	S/II	S/II	CO/II	GNR/II	S/II (pB-ALL)
CML	1st CP, failing 2nd or 3rd line TKI	S/II	S/II	CO/II	GNR/III
CML	Accelerated phase, blast crisis or >1st CP	S/II	S/II	CO/II	GNR/III
MDS and JMML		S/II	S/II	CO/III	GNR/III
NHL	CR1 (low risk)	GNR/II	GNR/II	GNR/II	GNR/II
	CR1 (high risk)	CO/II	CO/II	CO/II	CO/II
	CR2	S/II	S/II	CO/II	CO/II
HL	CR1	GNR/II	GNR/II	GNR/II	GNR/II
HL	1st relapse, CR2	CO/II	CO/III	CO/III	S/II
*Non-malignant disorders and solid tumours*
IBMFS		S/II	S/II	CO/II	NA
Acquired SAA	Newly diagnosed	S/II	S/II	D/II	NA
Acquired SAA	Relapse/Refractory	S/I	S/II	CO/II	NA
Germ cell tumours (refractory)		GNR	GNR	GNR	D
Sarcoma	Ewing’s sarcoma (high risk or >CR1)	D/II	D/III	D/III	CO
	Soft tissue sarcoma (high risk or >CR1)	GNR	GNR	GNR	GNR
	Osteogenic sarcoma	GNR/III	GNR/III	GNR/III	GNR
Neuroblastoma	High risk or >CR1	D	D	D	S/II	D/II (refractory)
Brain tumours		GNR/III	GNR/III	GNR/III	D
Wilms’ tumour	>CR1	GNR/III	GNR/III	GNR/III	D
Primary ID	SCID	S/II	S/II	S/II	NA
	Non-SCID CID	S/II	S/II	S or CO/II	NA
	Primary HLH S/II	S/II	S/II	S/II	NA
	Other primary ID	S/II	S/II	CO/II	NA
IEM	MPS-IH	S/II	S/II	S/II	NA
	Wolman disease^b	CO/III	CO/III	CO/III	NA
	MPSII–VII^b	CO/II	CO/II	CO/II	NA
	MLD	S/II	S/II	CO/II
PSD	X-ALD	S/II	S/II	CO/II	NA
Osteopetrosis		S/II	S/II	S/II	NA
AD	Including monogenic AD	CO/II	CO/OO	CO/II	CO/II
TDT	Absence of iron related severe/irreversible tissue/organ damage	S/II	S/II	CO/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.
AD autoimmune disorders, ALL acute lymphoblastic leukaemia, Allo allogeneic transplantation, AML acute myeloid leukaemia, Auto autologous transplantation, CML chronic myelogenous leukaemia, CO clinical option (can be carried after careful assessment of risks and benefits), CP chronic phase, CR1, 2 first, second complete remission, D developmental (further trials are needed), GNR generally not recommended, HL Hodgkin lymphoma, HCT haematopoietic cell transplantation, IBMFS inborn marrow failure syndromes (Fanconi anaemia, dyskeratosis congenita, Blackfan–Diamond anaemia and others), ID immunodeficiency, IEM inborn error of metabolism, JMML juvenile myelomonocytic leukaemia, MDS myelodysplastic syndromes, MLD metachromatic leukodystrophy, MMAD mismatched alternative donors (cord blood, haploidentical and mismatched unrelated donors), MPS mucopolysaccharidosis, MSD matched sibling donor, MUD well-matched unrelated donor (8/8, 10/10, or 9/10 if mismatched is in DQB1), PSD peroxisomal storage diseases, S standard of care (generally indicated in suitable patients), SAA severe aplastic anaemia, SCD sickle cell disease (high risk), SCID severe combined immunodeficiencies, TDT Transfusion dependent Thalassaemia, TKI tyrosine kinase inhibitors, X-ALD X-linked adrenoleukodystrophy.
^aCategories are based on number of white blood cells, cytogenetics and molecular markers at diagnosis and time to achieve remission (see text).
^bFor Wolman disease, MPSII and VII, decision is individualised after expert evaluation.
^#For thalassaemia and SCD, MMAD indication applies ONLY to haploidentical allo-HCT.

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Table 2 Proposed classification of transplant indications for children and adolescents—2025.

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