Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndrome: Current Status

Abstract

Hematopoietic cell transplantation (HCT) offers potentially curative therapy for patients with myelodysplastic syndrome (MDS). However, as the majority of patients with MDS is in the 7th or 8th decade of life, only few of these patients were transplanted following high-dose conditioning regimens. The development of reduced-intensity conditioning has allowed to apply HCT also to older patients and those with clinically relevant comorbid conditions. Dependent upon disease status and the type of clonal chromosomal abnormalities present at the time of HCT, some 25-75% of patients will be cured of their disease and survive long term. Recent results with HLA-matched unrelated donors are comparable to those with HLA genotypically identical siblings. The increasing use of cord blood and HLA-haploidentical donors is expected to make HCT available to a growing number of patients. However, post-transplant relapse and graft-versus-host disease remain problems requiring further instigations.

Impact of copy neutral loss of heterozygosity and total genome aberrations on survival in myelodysplastic syndrome

“…Currently, the only curative treatment for myelodysplastic syndrome is allogeneic hematopoietic cell transplantation( 8 ). The use of the International Prognostic Scoring System, now in a revised version, has aided physicians in identifying patients who may or may not benefit from hematopoietic cell transplantation( 9 ). The new Revised International Prognostic Scoring System takes into consideration marrow blast percentage, peripheral blood counts and cytogenetic findings, of which the latter has the most profound impact on prognosis.…”

Should elderly patients with higher-risk myelodysplastic syndromes undergo allogeneic hematopoietic stem cell transplantation?

“…Allogeneic stem cell transplantation (alloSCT) currently offers the only hope for cure. Recent progress, including use of reduced intensity conditioning (RIC), has reduced transplantation-related mortality (TRM) significantly therefore increasing the applicability of RIC alloSCT for elderly patients [6,7]. Nonetheless, alloSCT is still performed in a small fraction of patients [8].…”