The role of palliative and supportive care in haematopoietic cell transplantation and cellular therapy. Recommendations from the EBMT practice harmonisation and guidelines committee

Haematopoietic cell transplantation (HCT) and cellular therapies (CT), including chimeric antigen receptor (CAR) T-cell therapy, offer curative potential for patients with haematologic malignancies but are associated with substantial physical, psychological, social and existential burden. Despite growing evidence that early integration of palliative and supportive care improves quality of life (QoL), symptom control, communication, and decision-making, its implementation remains heterogeneous and often delayed. This EBMT Practice Harmonisation and Guidelines paper was developed using a structured expert-consensus process. An international multidisciplinary panel of clinicians with expertise in adult and paediatric HCT, CT and palliative care conducted targeted literature reviews and discussions to generate pragmatic, non-graded recommendations. Recommendations address key domains across the HCT and CT continuum, including symptom management, psychological distress, graft-versus-host disease, relapse, end-of-life care, advance care planning, caregiver support, health inequities, and healthcare professional factors. Evidence supports early, integrated palliative care to reduce symptom burden, improve QoL, and facilitate complex decision-making. Practical referral triggers, incorporation of patient-reported outcomes, and parallel planning are proposed to promote timely and equitable access. Palliative and supportive care should be systematically integrated throughout HCT and CT. These EBMT recommendations provide a framework to support holistic, person-centred care and harmonise clinical practice.