Allogeneic Stem Cell Transplantation for MDS

Myelodysplastic syndromes are clonal disorders with morphological dysplasia, a variable degree of cytopenia and risk transformation to acute myeloid leukemia. Prognosis is very defined by blast count, cytopenia, cytogenetics more recently somatic mutations, IPSS or revised score being the most widely used assess disease risk. HSCT remains only curative treatment date, high-risk patients obtaining biggest benefit. However, NRM should be carefully assessed before indicating transplant in this usually old population, where organ toxicity comorbid conditions considered. Multi-domain assessment tools, such as CGA (comprehensive geriatric assessment) EBMT score, useful context might guide physician decisions regarding transplant. Indeed, development reduced intensity conditioning regimens, number patient candidates for an has increased. Regarding pre-transplant treatment, excess > 10% treated HMAs chemotherapy, although there no randomized trials confirming benefit approach, even when achieving complete response. Concerning donor choice, matched sibling donors continue first option, unrelated donors, haploidentical have proven valid options offered absence related donor. Relapse main cause transplantation failure. MRD pre-emptive prophylactic use HMA other targeted inhibitors without DLI accepted strategies reduce relapse risk, but prognosis dismal, subject several ongoing clinical protocols.