NCCN Guidelines® Insights: Hematopoietic Cell Transplantation, Version 3.2022

Featured Updates to the NCCN Guidelines

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Ayman SaadThe Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute

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Alison LorenAbramson Cancer Center at the University of Pennsylvania

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Javier Bolaños-MeadeThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins

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George ChenRoswell Park Comprehensive Cancer Center

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Daniel CourielHuntsman Cancer Institute at the University of Utah

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Antonio Di StasiO’Neal Comprehensive Cancer Center at UAB

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Areej El-JawahriMassachusetts General Hospital Cancer Center

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Hany ElmariahMoffitt Cancer Center

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Sherif FaragIndiana University Melvin and Bren Simon Comprehensive Cancer Center

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Krishna GundaboluFred & Pamela Buffett Cancer Center

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Jonathan GutmanUniversity of Colorado Cancer Center

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Vincent HoDana-Farber/Brigham and Women’s Cancer Center

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Rasmus HoegUC Davis Comprehensive Cancer Center

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Mitchell HorwitzDuke Cancer Institute

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Joe HsuStanford Cancer Institute

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Adetola KassimVanderbilt-Ingram Cancer Center

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Mohamed Kharfan DabajaMayo Clinic Cancer Center

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John MagenauUniversity of Michigan Rogel Cancer Center

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Thomas MartinUCSF Helen Diller Family Comprehensive Cancer Center

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Marco MielcarekFred Hutchinson Cancer Center

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Jonathan MoreiraRobert H. Lurie Comprehensive Cancer Center of Northwestern University

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Ryotaro NakamuraCity of Hope National Medical Center

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Yago NietoThe University of Texas MD Anderson Cancer Center

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Cameron NinosUniversity of Wisconsin Carbone Cancer Center

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Caspian OliaiUCLA Jonsson Comprehensive Cancer Center

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Seema PatelCase Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute

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Brion RandolphSt. Jude Children’s Research Hospital/The University of Tennessee Health Science Center

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Mark SchroederSiteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine

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Dimitrios TzachanisUC San Diego Moores Cancer Center

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Asya Nina Varshavsky-YanovskyFox Chase Cancer Center

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Madhuri VusirikalaUT Southwestern Simmons Comprehensive Cancer Center

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Frankie AlgieriNational Comprehensive Cancer Network

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Lenora A. PluchinoNational Comprehensive Cancer Network

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The NCCN Guidelines for Hematopoietic Cell Transplantation (HCT) provide an evidence- and consensus-based approach for the use of autologous and allogeneic HCT in the management of malignant diseases in adult patients. HCT is a potentially curative treatment option for patients with certain types of malignancies; however, recurrent malignancy and transplant-related complications often limit the long-term survival of HCT recipients. The purpose of these guidelines is to provide guidance regarding aspects of HCT, including pretransplant recipient evaluation, hematopoietic cell mobilization, and treatment of graft-versus-host disease—a major complication of allogeneic HCT—to enable the patient and clinician to assess management options in the context of an individual patient’s condition. These NCCN Guidelines Insights provide a summary of the important recent updates to the NCCN Guidelines for HCT, including the incorporation of a newly developed section on the Principles of Conditioning for HCT.

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    Lee SJ, Logan B, Westervelt P, et al. Comparison of patient-reported outcomes in 5-year survivors who received bone marrow vs peripheral blood unrelated donor transplantation: long-term follow-up of a randomized clinical trial. JAMA Oncol 2016;2:15831589.

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  • 9.

    Alousi A, Wang T, Hemmer MT, et al. Peripheral blood versus bone marrow from unrelated donors: bone marrow allografts have improved long-term overall and graft-versus-host disease-free, relapse-free survival. Biol Blood Marrow Transplant 2019;25:270278.

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  • 10.

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  • 11.

    Luznik L, O’Donnell PV, Symons HJ, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose, posttransplantation cyclophosphamide. Biol Blood Marrow Transplant 2008;14:641650.

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  • 12.

    Bacigalupo A, Ballen K, Rizzo D, et al. Defining the intensity of conditioning regimens: working definitions. Biol Blood Marrow Transplant 2009;15:16281633.

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  • 13.

    McCune JS, Quinones CM, Ritchie J, et al. Harmonization of Busulfan Plasma Exposure Unit (BPEU): a community-initiated consensus statement. Biol Blood Marrow Transplant 2019;25:18901897.

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  • 14.

    Sorror ML, Storb RF, Sandmaier BM, et al. Comorbidity-age index: a clinical measure of biologic age before allogeneic hematopoietic cell transplantation. J Clin Oncol 2014;32:32493256.

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    Sorror ML. How I assess comorbidities before hematopoietic cell transplantation. Blood 2013;121:28542863.

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    Bubalo J, Carpenter PA, Majhail N, et al. Conditioning chemotherapy dose adjustment in obese patients: a review and position statement by the American Society for Blood and Marrow Transplantation practice guideline committee. Biol Blood Marrow Transplant 2014;20:600616.

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  • 17.

    Ijaz A, Khan AY, Malik SU, et al. Significant risk of graft-versus-host disease with exposure to checkpoint inhibitors before and after allogeneic transplantation. Biol Blood Marrow Transplant 2019;25:9499.

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  • 18.

    Merryman RW, Kim HT, Zinzani PL, et al. Safety and efficacy of allogeneic hematopoietic stem cell transplant after PD-1 blockade in relapsed/ refractory lymphoma. Blood 2017;129:13801388.

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  • 19.

    Pidala J, Kim J, Jim H, et al. A randomized phase II study to evaluate tacrolimus in combination with sirolimus or methotrexate after allogeneic hematopoietic cell transplantation. Haematologica 2012;97:18821889.

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  • 20.

    Khimani F, Kim J, Chen L, et al. Predictors of overall survival among patients treated with sirolimus/tacrolimus vs methotrexate/tacrolimus for GvHD prevention. Bone Marrow Transplant 2017;52:10031009.

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  • 21.

    Maziarz RT, Diaz A, Miklos DB, et al. Perspective: an international fludarabine shortage: supply chain issues impacting transplantation and immune effector cell therapy delivery. Transplant Cell Ther 2022;28:723726.

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  • 22.

    Chevallier P, Peterlin P, Garnier A, et al. Clofarabine-based reduced intensity conditioning regimen with peripheral blood stem cell graft and post-transplant cyclophosphamide in adults with myeloid malignancies. Oncotarget 2018;9:3352833535.

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  • 23.

    Saito T, Kanda Y, Kami M, et al. Therapeutic potential of a reduced- intensity preparative regimen for allogeneic transplantation with cladribine, busulfan, and antithymocyte globulin against advanced/refractory acute leukemia/lymphoma. Clin Cancer Res 2002;8:10141020.

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  • 24.

    Saito T, Kanda Y, Nakai K, et al. Immune reconstitution following reduced-intensity transplantation with cladribine, busulfan, and antithymocyte globulin: serial comparison with conventional myeloablative transplantation. Bone Marrow Transplant 2003;32:601608.

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  • 25.

    Markova M, Barker JN, Miller JS, et al. Fludarabine vs cladribine plus busulfan and low-dose TBI as reduced intensity conditioning for allogeneic hematopoietic stem cell transplantation: a prospective randomized trial. Bone Marrow Transplant 2007;39:193199.

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  • 26.

    Dimitrova D, Gea-Banacloche J, Steinberg SM, et al. Prospective study of a novel, radiation-free, reduced-intensity bone marrow transplantation platform for primary immunodeficiency diseases. Biol Blood Marrow Transplant 2020;26:94106.

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  • 27.

    Gvajaia A, Langston A, Esiashvil N, et al. Pentostatin/TBI conditioning is well-tolerated and permits engraftment of a second allogeneic stem cell transplant following primary or secondary rejection of an allogeneic hematopoietic stem graft. Blood 2019;134(Suppl 1):Abstract 5657.

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