Transplant Referral Timing Guidelines

Follicular

• Poor response to initial treatment
• Initial remission duration <24 months
• First relapse
• Transformation to diffuse large B-cell lymphoma

Diffuse Large B-Cell

• Primary induction failure, including residual PET avid disease
• First relapse
• CR2 or subsequent remission
• Double or triple hit (MYC and BCL-2 and/or BCL-6) – at diagnosis
• Primary CNS lymphoma at diagnosis PIF or first relapse

High Grade B-Cell

• MYC and BCL-2 and/or BCL-6 rearrangements
• Primary induction failure
• CR1
• First relapse
• CR2 or subsequent remission

Mantle Cell

• At diagnosis
• First relapse
• Bruton’s tyrosine kinase (BTK) intolerant or resistant disease

Mature T-cell

• CR1
• First relapse

Other High-Risk Lymphomas

• At diagnosis

Germ Cell Tumors

• Poor initial response
• Short initial remission

Neuroblastoma

• INSS stage 2 or 3 at diagnosis
  • MYCN amplification (>4x above reference)
• INSS stage 4 at diagnosis
  • MYCN amplification (>4x above reference)
  • age >18 months at diagnosis
  • age 12-18 months with unfavorable characteristics
• Metastatic disease at diagnosis
• Progressive disease while on therapy or relapsed disease

Ewing Family of Tumors

• Metastatic disease at diagnosis
• First relapse or CR2

Medulloblastoma

• First relapse or CR2

Immune Deficiency Diseases

(including severe comgined imunodeficiency syndromes, Wiskott-Aldrich syndrome, Omenn syndrome, X-linked lymphoproliferative syndrome, severe congenital neutropenia and others)

• At diagnosis or if detected on newborn screening

Inherited Metabolic Disorders

(including Hurler syndrome, adrenoleukodystrophy, and others)

• At diagnosis or if detected on newborn screening

Hemoglobinopathies

Sickle Cell Disease

• Children with available matched sibling donor
• All patients with aggressive course (stroke, end-organ complications, frequent pain crises)
• All patients with an alternative donor option and any of the following:
• Stroke or silent cerebral infarct or cognitive impairment >24 hours
• ≥2 episodes of acute check syndrome/2 year period [or] ‘Recurrent’ acute chest syndrome’
• Regular red blood cell transfusion therapy (8 or more per year)
• Tricuspid value regurgitant jet (TRJ) velocity ≥2.7 m/sec
• Chronic pain ≥6 months (leg ulcers, avascular necrosis) BMT CTN 1507 criteria only - in blue
• Abnormal transcranial Doppler (TCD) velocity of ≥200 cm/sec or >185 cm/sec with intracranial vasculopathy
• Silent cerebral infarct
• ≥3 severe vaso-occlusive pain crises per 2-year period

Transfusion-Dependent Thalassemias

• At diagnosis

Hemophagocytic Lymphohistiocytosis (HLH)

• At diagnosis

Severe Aplastic Anemia and Other Marrow Failure Syndromes
(including Fanconi anemia, Diamond-Blackfan anemia, Shwachman- Diamond syndrome and others)

• At diagnosis

Systemic Sclerosis

• At diagnosis or with diffuse disease, with increasing skin tightness score (modified Rodnan skin score, [mRSS]) and evidence of decrease (<80%) in % predicted pulmonary function tests: forced vital capacity (FVC) or/and diffusion capacity (DLCO).

Multiple Sclerosis (MS)

• After MS relapse, with ≥2 relapse episodes in past 3 years, while on disease modifying therapy. Refer patient prior to progression of severe disability: Patient must be able to walk 100 meters (with unilateral assistance: cane, crutch or brace).