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.
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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

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.