The European Society for Blood and Marrow Transplantation (EBMT) has unveiled its highly anticipated 2025 Clinical Practice Recommendations, marking a significant milestone in the evolution of haematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy. This ninth special report is set to redefine treatment paradigms across haematological malignancies, solid tumors, and immune disorders, providing a comprehensive framework for clinicians worldwide. By integrating the latest scientific advances and harmonizing clinical practices, the EBMT aims to enhance patient outcomes and foster robust real-world evidence.
Over the last twenty years, the EBMT’s guidelines have been meticulously updated to keep pace with the rapid developments in cellular therapies. The 2025 report underscores the critical importance of standardization across transplant centers, facilitating not only improved clinical results but also enabling large-scale data pooling essential for meta-analyses and longitudinal studies. This consistency is particularly vital given the complexity and multidisciplinary nature of haematopoietic transplantation and cellular immunotherapy, which require seamless collaboration among hematologists, immunologists, transplant specialists, and allied health professionals.
Central to the latest recommendations is the transformative role of innovative therapies, most notably CAR-T and advanced therapy medicinal products (ATMPs). These cutting-edge modalities have revolutionized treatment options for patients with relapsed or refractory hematologic diseases, with CAR-T therapies demonstrating remarkable efficacy in targeting malignant cells via genetically engineered T lymphocytes. The report delves into nuanced clinical indications for these therapies, balancing disease-specific factors such as remission status and genetic risk profiles alongside donor availability for transplant procedures.
The manuscript meticulously details the current evidence base and clinical data supporting both HCT and CAR-T applications, stratified by disease entity and patient demographics. Adult and pediatric populations are both addressed, highlighting the differential risk-benefit considerations intrinsic to these groups. The inclusion of precise disease-specific tables offers clinicians swift access to key guidance, encapsulating recommendations filtered through a rigorous evaluation of evidence hierarchy, patient condition, and therapeutic alternatives.
Beyond cellular immunotherapies, the report expands its scope to encompass gene therapy advances that are beginning to reshape treatment landscapes in inherited immune and hematologic disorders. These gene-editing technologies, often delivered through viral vectors or novel genome modification platforms, hold promise for durable cures without the morbidity associated with traditional transplantation. EBMT’s updated guidance calls attention to the integration of such modalities within existing treatment algorithms, urging practitioners to keep abreast of ongoing clinical trials and emerging regulatory approvals.
Quality assurance remains a cornerstone of the EBMT’s recommendations, with particular emphasis on adherence to Joint Accreditation Committee-International Society for Cellular Therapy and EBMT (JACIE) standards. These comprehensive quality benchmarks cover donor selection, graft manipulation, patient monitoring, and data reporting, collectively ensuring the highest degree of safety and efficacy. The report advocates for every transplant center to obtain and maintain JACIE certification, underscoring the impact of accredited practices on reducing procedural complications and improving survival metrics.
In recognition of the critical importance of real-world data, the EBMT calls for systematic reporting to its expansive patient registry. This centralized database aggregates outcomes from thousands of transplantations and cellular therapies performed internationally, serving as an invaluable resource for longitudinal studies, comparative effectiveness research, and post-marketing surveillance. Robust data capture enables nuanced assessment of long-term survival, late effects, and quality-of-life outcomes, thereby informing continuous refinement of clinical guidelines.
The guidelines endorse a multidisciplinary and patient-centric approach, requiring tailored treatment strategies that carefully weigh disease aggressiveness against procedural risks and alternative therapeutic options. Decision-making frameworks embedded in the recommendations prioritize not only overall survival but also long-term health, neurocognitive function, and quality of life, themes that reflect a paradigm shift towards holistic patient management. Clinicians are encouraged to collaborate across specialties and engage patients in shared decision-making to optimize individualized care plans.
Co-lead authors of the report, Raffaella Greco and Annalisa Ruggeri, emphasize the pivotal role of these comprehensive recommendations in enabling transplant centers affiliated with EBMT to provide cutting-edge therapies grounded in the latest scientific evidence. They advocate for widespread adoption of the guidelines, envisioning a future where harmonized clinical practice minimizes variability in patient outcomes and maximizes therapeutic benefit across diverse healthcare settings.
The evolution of cellular and gene therapies has introduced complex clinical decision-making challenges, particularly in the context of expanding indications and novel product approvals. The 2025 EBMT report serves as an essential navigational tool, distilling the avalanche of emerging data into actionable recommendations that reflect both evidence strength and clinical pragmatism. It supports clinicians in updating protocols, improving patient selection, and integrating innovative approaches without compromising safety or efficacy.
This landmark publication is accessible through prominent scientific channels and underscores EBMT’s commitment to advancing transplant science through transparent, evidence-based practice guidelines. As the field continues to evolve rapidly, these clinical recommendations provide a critical foundation for future research and clinical care, ensuring patients receive therapies that offer the best chance for durable remission and improved life quality.
In conclusion, the 2025 EBMT Clinical Practice Recommendations represent a watershed moment in the integration of haematopoietic transplantation and CAR-T therapy into standard clinical pathways. They strike a delicate balance between innovation and established protocols, emphasize data quality and multidisciplinary collaboration, and reinforce a patient-centered philosophy. Embedding these guidelines into routine care promises to accelerate therapeutic progress and elevate standards for patients grappling with some of the most challenging hematological and immunological disorders.
Subject of Research:
Haematopoietic cell transplantation (HCT) and chimeric antigen receptor T-cell (CAR-T) therapy indications for haematological diseases, solid tumours, and immune disorders.
Article Title:
Indications for haematopoietic cell transplantation and CAR-T for haematological diseases, solid tumours and immune disorders: 2025 EBMT practice recommendations
News Publication Date:
2 October 2025
Web References:
http://dx.doi.org/10.1038/s41409-025-02701-3
http://www.ebmt.org
References:
European Society for Blood and Marrow Transplantation (EBMT) 2025 Clinical Practice Recommendations, published in Bone Marrow Transplantation
Keywords:
Haematopoietic cell transplantation, CAR-T therapy, cellular immunotherapy, gene therapy, EBMT, JACIE accreditation, haematological malignancies, solid tumors, immune disorders, advanced therapy medicinal products (ATMPs), multidisciplinary approach, real-world evidence
