Allogeneic Hematopoietic Cell Transplantation in Myelodysplastic Syndrome Patients

Myelodysplastic syndromes (MDS) are a group of heterogeneous clonal hematopoietic stem cell disorders. The 2020 Surveillance, Epidemiology, and End Results data demonstrates the incidence rate of MDS increases with age especially in those greater than 70 years. Allogeneic hematopoietic cell transplantation (HCT) for MDS is a potentially curative procedure, but is associated with a significant risk of morbidity and mortality. Appropriate patient selection is of outmost importance to optimize HCT outcomes and maximize the outcome expectation of MDS patients. The international prognostic scoring systems (IPSS) and the revised IPSS (IPSS-R) are used to identify high-risk patients and guide decision making. Neither scoring system incorporates molecular mutations, which are now recognized as important prognostic factors for clinical outcomes. Patient and disease characteristics including age, comorbidity, iron overload, blast percentage, are also known to impact transplant outcomes in MDS patients. With better understanding of disease biology and prognosis and with different types of conditioning regimens as well as different graft sources, a transplant strategy should be tailored to the individual host to maximize the benefits of this procedure.