Updated recommendations published for post-HCT screening and preventative practices for long-term survivors after cell therapy
February 2024
An international group of experts convened to review the latest in research literature and clinical practice to update and publish new consensus guidelines on post-transplant care and long-term screening recommendations for survivors after hematopoietic cell transplant (HCT) and other cell therapies. Specific recommendations were classified based on the strength of the evidence supporting the recommendation across all major organ systems. As HCT and cell therapies expand and become more accessible globally, there is a growing need to adapt these guidelines to reflect the latest advancements and challenges in patient care, optimizing long-term care and survivorship planning for patients post-HCT.
Download a PDF to the study highlights and citation here
Background
This update provides essential revisions to guidelines originally established in 2006 and last updated in 2012. The initial guidelines were created to address the increasing number of long-term survivors of HCT and cell therapy, focusing on the need for standardized screening and prevention. With the number of HCT procedures rising annually and the expansion of cell therapy to new medical indications, these guidelines required updating to ensure their continuing utility and relevance. This update aimed to incorporate the latest research findings and expert consensus to better serve both patients and health care providers in this rapidly evolving field.
Methods
The update process was a collaborative effort involving an international group of 30 experts in the field. A core group of 7 participants initially reviewed the 2012 guidelines and proposed new topics, areas of emphasis and changes in formatting. These suggestions were then reviewed by the larger group, and subgroups of 2 to 4 members were tasked with reviewing relevant literature and drafting the content for specific sections.
Consensus on the recommendations was achieved through a structured voting process. Recommendations were adopted if there was at least 85% agreement among participants. If consensus was below this threshold, the recommendation was revised and subjected to another round of voting. Recommendations that failed to reach more than 50% consensus were abandoned. The final recommendations were categorized similarly to the National Comprehensive Cancer Network (NCCN) approach, with classifications indicating the level of consensus and evidence supporting each guideline.
Results
The updated guidelines include multiple new recommendations for screening and preventative practices, reflecting the evolving needs of long-term survivors of HCT and cell therapy. These guidelines emphasize the importance of tailoring care to the specific needs of patients based on their underlying HCT indications or comorbidities. The consensus-driven process ensures that the recommendations are both evidence-based and reflective of expert opinion, providing a reliable framework for health care providers.
Recommendations are organized by major organ system and other high-level categories for consideration. Some examples are included in the Figure below.
Key takeaways
The updated guidelines have significant implications for the field of transplant and cell therapy. By providing updated recommendations, the guidelines offer health care providers better tools for decision-making in screening and preventative treatment. The updated guidelines are crucial for recognizing longer-term risk factors in patients and use of preventative practices to minimize risk, including the early detection of graft-versus-host disease. Ensuring that these guidelines are widely disseminated and implemented in practice will be key to enhancing patient outcomes and advancing the field of HCT and cell therapy.
NMDPSM adapted the guidelines for distribution through a mobile app and online, making it easier for clinicians to access and implement into practice.
Figures
These figures display a non-exhaustive list of key updates from each organ system category.
