In recent years, tremendous progress has been made in the management of B-cell lymphomas. The introduction of monoclonal antibodies, bispecifics, CAR-T cells and targeted small molecules has dramatically reshaped their prognosis, turning once-fatal conditions into increasingly chronic diseases.1 By contrast, T-cell lymphomas have remained the ‘poor cousins’ of hematologic malignancies, with therapeutic innovation lagging behind. In this context, the work of Damaj et al. and the EBMT Practice Harmonization and Guidelines Committee, published in this journal,2 represents a timely and much-needed contribution (Figure 1). Cutaneous T-cell lymphomas (CTCL), including mycosis fungoides and Sézary syndrome, exemplify this therapeutic stagnation. Despite decades of clinical research, curative options remain exceedingly limited, and median overall survival for advanced stages often does not exceed 5 years.3 Targeted therapies such as brentuximab vedotin or mogamulizumab have improved disease control and quality of life for subsets of patients but rarely induce durable remissions.4, 5 As a result, allogeneic haematopoietic cell transplantation (allo-HCT) remains the only potentially curative approach, harnessing the graft-versus-lymphoma effect to achieve long-term disease control in selected cases.6 Yet, because CTCLs are rare, heterogeneous and often indolent, prospective randomized trials are virtually impossible to conduct. Existing evidence derives mainly from small retrospective series and registry data, leading to heterogeneity in referral patterns, transplant timing, conditioning regimens and donor selection. It is precisely this vacuum of harmonized guidance that the EBMT group has now addressed.2 Their consensus recommendations, developed jointly by dermatologists and transplant haematologists, provide pragmatic answers to the key clinical questions: Which patients should be transplanted, when and how? The strength of these guidelines lies in their multidisciplinary and data-driven pragmatism. They emphasize early referral for transplant evaluation in high-risk patients, those with large-cell transformation, advanced stage or relapsed/refractory disease, while recognizing the need for meticulous patient selection based on frailty, comorbidities and disease kinetics. They advocate reduced-intensity conditioning as the preferred approach, balancing curative potential with tolerability7 and highlight the importance of achieving disease control prior to transplant. Importantly, they also provide structured guidance for post-transplant monitoring and relapse management, acknowledging the crucial role of dermatologists in diagnosing skin relapses and distinguishing them from graft-versus-host disease. Nonetheless, the authors wisely underline the limitations inherent in expert-based consensus. In the absence of randomized evidence, these recommendations rest on the collective experience of specialized centres and must be interpreted as dynamic rather than definitive. Key questions remain unanswered, such as the optimal role of measurable residual disease monitoring, maintenance strategies post-transplant or the integration of emerging immunotherapies and cellular approaches. Encouragingly, the guidelines call for future research into novel immune-based therapies, including CAR-T cells and bispecific antibodies, which may eventually complement or even replace transplantation in selected cases. Beyond its clinical content, this document carries symbolic significance. It reaffirms our collective responsibility for evidence generation and consensus building in rare diseases, where traditional trial structures fail. By offering standardized algorithms adaptable across the globe, the group has set a benchmark for harmonization and collaborative practice between dermatologists and haematologists, an essential step towards improving patient outcomes in this neglected field. In summary, this consensus represents a most welcome addition to the literature. It bridges a long-standing gap in the management of cutaneous T-cell lymphomas, providing clinicians with an informed and practical roadmap. While acknowledging the fragility of current evidence, it highlights the need for collaborative data collection and innovative trial designs to refine the role of allogeneic transplantation. Until transformative therapies emerge, transplantation remains the cornerstone, and for many patients, the only path to cure. The authors would like to acknowledge the outstanding contribution, efforts and dedication of all stakeholders involved in this consensus project. No funding supported this work. MM reports grants and lecture honoraria from Janssen, Sanofi, Maat Pharma and JAZZ Pharmaceuticals, lecture honoraria from Celgene, Amgen, BMS, Takeda and Pfizer, grants from Roche, all outside the submitted work. FM reports lecture honoraria from Therakos/Mallinckrodt, BMS, MSD, Sanofi, Novartis, Astra Zeneca and JAZZ Pharmaceuticals, all outside the submitted work. Not applicable. Data sharing is not applicable to this article as no new data were created or analysed in this study.
Mohty et al. (Tue,) studied this question.