The American Society for Transplantation and Cellular Therapy (ASTCT) just released a 2026 guideline on hematopoietic cell transplantation for blastic plasmacytoid dendritic cell neoplasm (BPDCN). The guideline, Hematopoietic Cell Transplantation for Blastic Plasmacytoid Dendritic Cell Neoplasm features 17 recommendations, grouped by clinical scenario, and was developed to help clinicians identify the optimal role of hematopoietic cell transplantation in eligible patients.

The ASTCT plans to update the guideline every five years or as needed if new evidence emerges. Below is a rundown of the recommendations in their relevant clinical scenario groupings. View the full-text version to view the complete guideline, including associated discussion points and more.

Recommendations from the 2026 ASTCT Guideline on Hematopoietic Cell Transplantation for BPDCN

Staging Work Up To Confirm CR

  • The panel recommends a BM aspirate, biopsy, flow cytometry, a PET-CT, a diagnostic LP, and a thorough skin exam to confirm CR prior to proceeding with a HCT.

HCT Consolidation in CR1

  • The panel recommends consolidation with an allogeneic HCT in patients with confirmed CR1.
  • The panel suggests autologous HCT for patients in CR1 not considered fit for an allogeneic HCT provided that there is no evidence of bone marrow involvement with BPDCN.

HCT in CR2

  • The panel recommends consolidation with an allogeneic HCT in patients with confirmed CR2.
  • The panel suggests autologous HCT for patients in CR2 not considered fit for an allogeneic HCT provided that there is no evidence of bone marrow involvement with BPDCN.

HCT in PIF or Active R-R

  • The panel does not recommend allogeneic HCT for patients with primary induction failure or active relapsed-refractory disease.
  • The panel does not recommend autologous HCT for patients with primary induction failure or active relapsed-refractory disease.

Post-Transplant Intrathecal Chemotherapy

  • The panel suggests post-transplant IT chemotherapy in all patients with BPDCN regardless of prior evidence of CNS involvement and/or residual CNS disease.

Post-Transplant Maintenance/Consolidative Chemotherapy or Targeted Therapy

  • The panel does not suggest maintenance/consolidative chemotherapy or targeted therapy to all patients with BPDCN who received an allogeneic HCT regardless of remission status at time of transplant.
  • The panel suggests maintenance/consolidative chemotherapy or targeted therapy only to patients who received an allogeneic HCT in CR2 or beyond.
  • The panel does not recommend maintenance/consolidative chemotherapy or targeted therapy only in patients who received an allogeneic HCT using reduced intensity conditioning regimens.
  • The panel does not recommend maintenance/consolidative chemotherapy or targeted therapy only in patients who received an autologous HCT.

Post-HCT Surveillance of BPDCN

  • The panel recommends disease surveillance sometime between day +30 and +90, at 6 months, at 1 year, at 18 months and at 2-year post-transplantation.

MAC Regimen with TBI in CR1

  • The panel recommends allogeneic HCT using a MAC regimen with TBI, for young and/or fit patients with BPDCN in CR1.

RIC Regimen in CR1

  • The panel recommends allogeneic HCT using a RIC regimen for older and/or frail patients with BPDCN in CR1.

MAC Regimen with TBI in CR2

  • The panel recommends allogeneic HCT using a MAC regimen with TBI, for young and/or fit patients with BPDCN in CR2.

RIC Regimen in CR2

  • The panel recommends allogeneic HCT using a RIC regimen for older and/or frail patients with BPDCN in CR2.

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