The myelodysplastic syndrome (MDS) encompasses a series of hematological conditions characterized by chronic cytopenias with abnormal cellular maturation. Based on the cytopenias, number of blast cells in bone marrow and cytogenetic abnormalities, MDS may be best classified by the International Prognostic Scoring System (IPSS) in four groups: low risk, intermediate 1, intermediate 2 risks and high risk. A subset of patients can be cured following allogeneic hematopoietic stem cell transplantation (SCT). This therapy should be considered for under 60-year-old patients with an HLA-matched sibling donor. The decision in favor of this aggressive therapy depends upon a number of criteria including the IPSS score, risk of disease progression, risk of infection, and the overall health of the patient. Autologous HCT can be considered for those rare patients who are successfully induced into complete remission and do not have an HLA-matched donor. Non-myeloablative allogeneic HCT appears promising for patients with MDS who are not candidates for myeloablative allogeneic HCT. Early results are encouraging. Despite an increased relapsed rate, the treatment-related mortality is lower. Patients should be enrolled in well-designed clinical trials attempting to address the important issues of patient comorbidities, GVHD, and relapse risk.
Hematopoietic cell transplant; myelodysplastic syndromes
