Table 3.
Proposed classification of transplant indications for children and adolescents—2022.
| Disease | Disease status and subtypes | MSD allo | MUD allo | MMAD allo | Auto |
|---|---|---|---|---|---|
| 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 |
| CR1 (high risk)a | S/II | S/II | CO/II | GNR/II | |
| CR2 | S/II | S/II | CO/II | GNR/II | |
| >CR2 | S/II | S/II | CO/II | GNR/II | |
| CML | 1st CP, failing 2nd or 3rd line TKI | S/II | S/II | CO/II | GNR/III |
| 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 |
| 1st relapse, CR2 | CO/II | CO/III | CO/III | S/II | |
| Non-malignant disorders and solid tumours | |||||
| 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 | NA | |
| Other primary ID | S/II | S/II | CO/II | NA | |
| MPS | MPS-1H | S/II | S/II | S/II | NA |
| Wolman diseaseb | CO/III | CO/III | CO/III | NA | |
| MPSII–VIIb | CO/II | CO/II | CO/II | NA | |
| MLD | S/II | S/II | CO/II | ||
| PSD | X-ALD | S/II | S/II | CO/II | NA |
| Thalassaemia and SCD | S/II | CO/II | CO/II | NA | |
| Osteopetrosis | S/II | S/II | S/II | NA | |
| IBMFS | S/II | S/II | CO/II | NA | |
| Acquired SAA | S/II | S/II | CO/II | NA | |
| Germ cell tumours | CO/II | CO/II | CO/II | CO/II | |
| Sarcoma | Ewing’s sarcoma (high risk or >CR1) | D/II | D/III | D/III | S/II |
| Soft tissue sarcoma (high risk or >CR1) | D/II | D/II | D/III | CO/II | |
| Osteogenic sarcoma | GNR/III | GNR/III | GNR/III | D/II | |
| Neuroblastoma | High risk or >CR1 | CO/II | CO/II | D/III | S/II |
| Brain tumours | GNR/III | GNR/III | GNR/III | CO/II | |
| Wilms’ tumour | >CR1 | GNR/III | GNR/III | GNR/III | CO/II |
| AD | Including monogenic AD | CO/II | CO/II | CO/II | CO/II |
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), CR1, 2 first, second complete remission, D developmental (further trials are needed), GNR generally not recommended, HL Hodgkin lymphoma, HSCT haematopoietic stem cell transplantation, IBMFS inborn marrow failure syndromes (Fanconi anaemia, dyskeratosis congenita, Blackfan–Diamond anaemia and others), ID immunodeficiency, 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, 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.