Bone Marrow Transplantation (2002) 29, 639–646
 2002 Nature Publishing Group All rights reserved 0268–3369/02 $25.00
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Special report
Allogeneic and autologous transplantation for haematological diseases,
solid tumours and immune disorders: definitions and current practice
in Europe
A Urbano-Ispizua1, N Schmitz2, T de Witte3, F Frassoni4, G Rosti5, H Schrezenmeier6,
E Gluckman7, W Friedrich8, C Cordonnier9, G Socie7, A Tyndall10, D Niethammer11,
P Ljungman12, A Gratwohl13, J Apperley14, D Niederwieser15 and A Bacigalupo14 for the European
Group for Blood and Marrow Transplantation
1Dept of Hematology, Hospital Clinic, Barcelona, Spain; 2Dept of Hematology, AK St Georg, Hamburg, Germany; 3Dept of
Hematology, University Medical Center St. Radboud, Nijmegen, The Netherlands; 4Dept of Hematology, Ospedale San Martino,
Genova, Italy; 5Dept of Onco-Hematology, Ospedale Civile, Ravenna, Italy; 6Dept of Hematology, Oncology, Transfusion Med,
University Hospital Benjamin Franklin, Berlin, Germany; 7Dept of Hematology, BMT Unit, Hoˆpital St. Louis, Paris, France; 8Abt
Pa¨diatrie II, University of Ulm, Ulm, Germany; 9Dept of Hematology, Hoˆpital Henri Mondor, Cre´teil, France; 10Reumatologische
Universita¨tsklinik, Felix Platter Spital, Basel, Swizerland; 11Dept of Pediatrics, University Hospital, Tu¨bingen, Germany; 12Dept of
Hematology, Huddinge University Hospital, Huddinge, Sweden; 13Dept of Hematology, Kantonsspital, Basel, Switzerland; 14Dept of
Haematology, Imperial College School of Medicine, Hammersmith Hospital, London, UK; and 15Div Internal Med II, University of
Leipzig, Germany
Summary:
The Accreditation Sub-Committee of the EBMT regu-
larly publishes special reports on current practice of
haemopoietic stem cell transplantation for haematolog-
ical diseases, solid tumours and immune disorders.
Major changes have occurred since the last report in
1998. Haemopoietic stem cell transplantation today
includes allogeneic and autologous stem cells derived
from bone marrow, peripheral blood and cord blood.
With reduced intensity conditioning regimens in allog-
eneic transplantation, the age limit has increased, per-
mitting the inclusion of older patients. New indications
have emerged, such as autoimmune disorders and AL
amyloidosis for autologous, and solid tumours for allog-
eneic transplants. Other indications, such as autologous
transplantation for breast cancer have been challenged.
An updated report with revised tables and operating
definitions is presented here.
Bone Marrow Transplantation (2002) 29, 639–646. DOI:
10.1038/sj/bmt/1703535
Keywords: haemopoietic transplantation; indications;
recommendations; practice; Europe
In 1996, the Accreditation Sub-Committee of the EBMT
published a special report in which allogeneic (allo) and
autologous (auto) haemopoietic stem cell transplant
Correspondence: A Bacigalupo, Department of Haematology, Ospedale
San Martino, Viale Benedetto XV, 16132 Genova, Italy
Received 11 May 2001; accepted 24 November 2001
(HSCT) procedures were classified in accordance with pre-
vailing practice in Europe.1 The published table categorised
haemopoietic transplant procedures by patient diagnosis,
stage of disease, patient age and source of stem cells. Pro-
cedures involving predominantly adults and those involving
children were classified in the same table. In 1998, the same
group published an updated article in which new indi-
cations for transplant procedures were recognised and cer-
tain indications were modified.2 In addition, these issues
were addressed separately in adults and children. Since
then, some new indications for transplant procedures have
been recognised and certain accepted indications have been
modified. Allogeneic stem cell transplantation with reduced
intensity conditioning may be used for patients not eligible
for a standard allogeneic transplant because of age and/or
clinical condition. The increasing use of two alternative
sources of progenitor cells for allogeneic transplants, ie per-
ipheral blood and cord blood, is also discussed. The
updated classification is presented below (Table 1). As in
the two previous articles, it was not our intention to review
the literature in detail nor to provide reasoned arguments in
favour of or against the decision to offer a given patient a
transplant in a particular clinical situation. Rather, we have
attempted to summarise the opinions and practice of clin-
icians working in transplant centres in Europe in 2001.1–3
Definitions
Haemopoietic stem cell transplant (HSCT)
HSCT refers to any procedure where haematopoietic stem
cells of any donor type and any source are given to a recipi-
ent with the intention of repopulating/replacing the haemato-

Stem cell transplant practice in Europe
A Urbano-Ispizua et al
640
Bone Marrow Transplantation
Table 1 Proposed classification of transplant procedures for adults – 2001
Disease Disease status Allo Auto
Sibling Alternative
donor donor
AML CR1, CR2 S CP S
CR3, incipient relapse S CP CP
M3 Molecular persistencea S CP NR
M3 2nd Molecular remission S CP S
Relapse or refractory CP NR NR
ALL CR1 (high risk), CR2, incipient relapse S S CP
Relapse or refractory CP NR NR
CML Chronic phase S S CP
Accelerated phase S S NR
Blast crisis D NR NR
Myeloproliferative disorders (non-CML) CP D D
Myelodysplastic syndrome RA, RAEB S S CP
RAEBt, sAML in CR1 or CR2 S CP CP
More advanced stages S CP NR
CLL S D CP
NHL
High and intermediate grade CR1 NR NR S
Relapse, CR2, CR3 CP CP S
Refractory CP NR NR
Low grade CR1 NR NR CP
Relapse, CR2, CR3 CP D S
Hodgkin’s disease CR1 NR NR CP
1st relapse, CR2, CR3 CP NR S
Refractory CP NR CP
Myeloma CP D S
Severe aplastic anaemia Patient
45 years S D NR
Paroxysmal nocturnal hemoglobinuria CP D
Solid tumours
Breast cancer Adjuvant and inflammatory NR NR CP
Breast cancer Metastatic responding D NR CP
Germ cell tumours Sensitive relapses NR NR S
Germ cell tumours Refractory NR NR CP
Ovarian cancer MRD NR NR CP
Ovarian cancer Refractory D NR NR
Glioma Post-surgery NR NR D
Small cell lung cancer (limited/‘good’) Upfront NR NR CP
Renal cell carcinoma Metastatic D NR NR
Autoimmune disorders
ITP with bleeding — — D
Systemic sclerosis — — D
Rheumatoid arthritis — — D
Multiple sclerosis — — D
SLE — — D
Amyloidosis (AL) D NR D
S = in standard use for selected patients; CP = to be undertaken in approved Clinical Protocols; D = developmental or pilot studies can be approved
in specialist units; NR = not generally recommended; MRD = minimal residual disease; CR1, 2, 3 = first, second, third complete remission; RA =
refractory anaemia; RAEB = refractory anaemia with excess blasts; sAML = secondary acute myeloid leukaemia. This classification does not cover
patients for whom a syngeneic donor is available. Haemopoietic transplant is not recommended for either breast cancer with refractory metastasis and
for non-small cell lung cancer.
aAfter consolidation or salvage treatment.
poietic system in total or in part. Chimerism studies are used
to monitor the replacement. The goal of the procedure should
be defined beforehand and documented informed consent
from the patient (and donor) should be obtained prior to the
procedure.
Donor lymphocyte infusions (DLI)
DLI refers to any situation where lymphocytes from a pre-
vious donor of haemopoietic stem cells are given to the
same recipient with the intention of treating or preventing