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Timing of Referral

                                                                                    HCT Transplantation: Version 7.0

Recommended Timing of Referral for HCT Evaluation

The following recommendations have been published jointly by the NMDP and ASBMT in 2017 and represent the consensus of an expert panel of nationally recognized bone marrow transplant physicians.

Source: Evidence-based Reviews, American Society of Blood and Marrow Transplantation, “2017” Referral Guidelines.  Published in Biology of Blood and Marrow Transplantation and available online here.

Adult Leukemias and Myelodysplasia
1.    Acute Myelogenous Leukemia
            High-risk AML including:
                •    Antecedent hematologic disease (e.g., myelodysplasia (MDS))
                •    Treatment related leukemia
                •    Induction failure
            CR1 with poor-risk cytogenetics
            CR2 and beyond

2.    Acute Lymphoblastic Leukemia
            CR1 up to age 35

            High-risk over age 35 including:
                •    Poor-risk cytogenetics (e.g., Philadelphia chromosome (t(9:22)) or
                     11q23 rearrangements)
                •    High WBC (> 30,000 – 50,000) at diagnosis
                •    CNS or testicular leukemia
                •    No CR within 4 weeks of initial treatment
                •    Induction failure
            CR2 and beyond

3.    Myelodysplastic Syndromes (MDS)
            Intermediate-1 (INT-1, internmediate-2 (INT-2) or high IPSS score
            which includes either:
                •    > 5% marrow blasts
                •    Other than good risk cytogenetics (good risk includes 5q- or normal)
                •    > 1 lineage cytopenia

4.    Chronic Myelogenous Leukemia (CML)
                •    No hematologic or minor cytogenetic response 3 months post-imatinib
                     (Gleevec) initiation
                •    No complete cytogenetic response 6 to 12 months post-imatinib initiation
                •    Disease progression
                •    Accelerated phase
                •    Blast crisis (myeloid or lymphoid)


Pediatric Acute Leukemias

1.    Acute Myelogenous Leukemia (AML)
                •    Monosomy 5 or 7
                •    Age < 2 years at diagnosis
                •    Induction failure
            CR1 with HLA matched sibling donor
            CR2 and beyond

2.    High-Risk Acute Lymphoblastic Leukemia (ALL)
                •    Induction failure
                •    Philadelphia chromosome positive
                •    WBC > 100,000 at diagnosis
                •    11q23 rearrangement
                •    Mature B-cell phenotype (Burkitt’s lymphoma)
                •    Infant at diagnosis
            CR1 Duration < 18 months
            CR3 and beyond


1.    Non-Hodgkin’s Lymphoma
                •    Poor response to initial treatment
                •    Initial remission duration < 12 months
                •    Second relapse
                •    Transformation to diffuse large B-cell lymphoma

            Diffuse Large B-Cell
                •    At first or subsequent relapse
                •    CR1 for patients with high or high-intermediate IPI risk
                •    No CR with initial treatment

            Mantle Cell
                •    Following initial therapy

2.    Hodgkin’s Lymphoma (Hodgkin’s Disease)
                •    No initial CR
                •    First or subsequent relapse

Multiple Myeloma

                •    After initiation of therapy
                •    At first progression