How I reduce and treat posttransplant relapse of MDS

Abstract

Allogeneic hematopoietic stem cell transplant (HSCT) is the only potentially curative option for patients with high-risk myelodysplastic syndromes (MDS). Advances in conditioning regimens and supportive measures have reduced treatment-related mortality and increased the role of transplantation, leading to more patients undergoing HSCT. However, post-transplant relapse of MDS remains a leading cause of morbidity and mortality for this procedure necessitating expert management and ongoing results analysis. In this article, we review treatment options and our institutional approaches to managing MDS relapse after HSCT using illustrative clinical cases that exemplify different clinical manifestations and management of relapse. We address areas of controversy relating to conditioning regimen intensity, chemotherapeutic bridging, and donor selection. In addition, we discuss future directions for advancing the field, including (1) the need for prospective clinical trials separating MDS from AML and focusing on post-transplant relapse, as well as (2) the validation of measurable residual disease methodologies to guide timely interventions.