Hematopoietic cell transplantation (HCT) in MDS patients of older age

Latest Insights and Therapeutic Advances in Myelodysplastic Neoplasms

“…In addition, quality of life (QoL) [64] has an ever-growing importance in clinical practice and research. In addition, the evaluation of comorbidities has a crucial role in decision making [65] and in establishing potential eligibility for allogeneic stem cell transplantation (SCT) [66][67][68][69][70]. Generally speaking, MDS patients with an LR of AML evolution require treatment of their cytopenias, while patients with HR-MDS are expected to undergo pre-emptive therapies of disease progression and curative treatments whenever applicable [62,63].…”

“…Furthermore, MDS-biTP53 entities [45][46][47][48], in light of the new classifications [1,2] and its unfavourable clinical course and poor prognosis, are addressed at the end of the paragraph that deals with HR-MDS. Lastly, the crucial topic of allogeneic SCT [66][67][68][69][70], the fundamental goal for eligible patients and the only real treatment opportunity in this difficult-to-treat setting, will be addressed in a distinct paragraph.…”

“…Compared to LR-MDS, the clinical management of HR patients significantly differs, in line with the AML approach [2,62,63], aiming at modifying the natural disease history, prolonging survival [80,81], and possibly achieving adequate disease control or cure through allogenic STC, which should be considered early in the disease course and promptly proposed to eligible patients [66][67][68]. HMAs, given with a life-prolonging intent and/or to reduce disease burden for subsequent allogeneic SCT, are still currently the standard of care for patients with HR-MDS [62,63,[103][104][105].…”

“…Recent reviews [67,68] and consensus treatment recommendations (Table 3) confirm that allogeneic SCT confers survival benefits in patients with HR-MDS compared to non-transplantation approaches. The use of allogeneic SCT is increasing in older patients with acceptable performance status and without a severe burden of comorbidities [66]. Administration of novel therapies before or after transplantation may decrease the risk of disease relapse in selected populations [68].…”

“…Less intense conditioning regimens and improvements in supportive therapy have reduced transplant-related mortality and increased access to this curative treatment. The timing of the transplant procedure in the course of the disease is crucial, and factors such as disease progression, geriatric assessment, comorbidities evaluation, and the identification of transplant-specific risk factors should be considered [66]. Allogeneic SCT remains the only curative option for MDS and is also used to treat MDS-associated rheumatologic conditions, such as VEXAS syndrome [70].…”