Echelon classification


Echelon Classification within HOVON: Optimizing the performance of patient-related studies

Conducting trials places increasing demands on participating hospitals and specialists and on the HOVON organization. This is justified: all these requirements increase the quality of the trials and the reliability of the results.

In order to guarantee the quality of trials, it is necessary to know which hospital can participate in which type of trial. HOVON has a policy for selecting hospitals for participation in trials. This is described in the HOVON policy “site selection”. General criteria apply to a hospital plus criteria to be determined per trial. The hospital specific criteria are represented by the echelon level.

Such echelon classification is necessary for center-based monitoring, it indicates what still needs to be done in centers to achieve a desired echelon, and generally allows for quality control.

In 2008, an inventory was made for the first time at all hospitals in the Netherlands with the coordinating hematologist whether and if so in which echelon his / her hospital wants and can participate in HOVON studies.

In 2011, an update of the echelon took place. In 2012, the echelon classification of the participating hospitals was re-examined according to the new criteria. The HDC monitors issued an advice, after which the executive board of HOVON issued an echelon to each participating center.

Details can be found in the HOVON policy “echelon classification”. The requirements will be adjusted from time to time. It is clear that any change, preferably upgrading, in the echelon level from participating hospitals is eagerly awaited.

At the section Hospitals, you are able to find for each site the echelon level.

Echelon classification of HOVON participants

For allogeneic and autologous stem cell transplants there is a licensing system from VWS, based on criteria of the Health Council (Hemapoietic stem cells; Health Council, 10-09-2003). These criteria, partly modified, can be used to define "intensive care" echelons. In addition, there will be hospitals that are able to participate in "non-intensive care" trials. Such an echelon classification of hemato-oncological care in hospitals fits well with the HOVON hospital-specific monitoring and is in harmony with future proposals from the NVvH for echelon classification of the (entire) hematological care and education.

The transplant echelon centers are JACIE accredited. In addition, the echelon criteria are reviewed during hospital-specific monitoring visits (site evaluation visits). Hospital-specific monitoring for quality has the important advantages that this review looks at the hospital as a center suitable for conducting certain types of studies. This hospital-specific monitoring is also more 'economic' and makes HOVON a fast-acting trial organization.

The classification and criteria of the echelons are described in the HOVON policy “echelon classification” (please find them at our policy section – after log in). There are 5 echelon levels:

  • Level A, hospitals in possession of a permit for allogeneic and autologous stem cell transplants
  • Level B, hospitals in possession of a permit for autologous (but not allogeneic) stem cell transplantation
  • Level C-HIC, hospitals that can provide intensive hematological care, such as acute leukemia treatment
  • Level C-SCT, hospitals that can provide aftercare after autologous stem cell transplants
  • Level D, hospitals that can provide non-intensive hematological care, without long-term and / or deep pancytopenia

A center may qualify for classification in both Level C-HIC and Level C-SCT if both sets of criteria are met.


In the hematological environment within the Netherlands, care and participation in trials are centered around the 10 consultation centers: 8 academic centers, the MST in Enschede and the Haga Hospital in The Hague.

Level C and D hospitals can provide clinical care in a HOVON trial context if there are agreements about consultation with a Level A or Level B hospital. In all forms of consultation about an individual patient, the doctor requesting consultation will record the status with whom he has consulted and what the advice is.

Level C-SCT hospitals can provide transplant-related care in a HOVON trial context if it has been agreed in detail with a Level A or Level B hospital. This requires collaboration according to JACIE standards.

Hospitals in echelon C and D can participate in studies that require echelon A or B for parts of the treatment, if they have agreements with such echelon A or B hospital.