Haema 2012; 3(2): 175-182
by Ioanna Sakellari
Hematology Department and HCT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
Abstract
Despite the development of numerous novel agents and the arguments for and against allogeneic hematopoietic cell transplantation (HCT), it should be kept in mind that myelodysplastic syndrome (MDS) is an incurable disease with conventional, non transplant therapy. The timing of HCT, a potentially curative therapeutic strategy, has been also judged as important key decision in the approach to the patient with MDS. The past several years have witnessed substantial progress in the biological characterization of MDS, in further refining prognostic models and in clear improvement of HCT concerning sibling, unrelated and cord blood transplants. After a proper patient stratification based on the IPSS, WPSS, MDACC, HCT-CI models, the possibility of an alternative transplant is feasible and successful in the era of RIC-HCT even for the older patients with high risk MDS. RIC- HCT has expanded the use of this treatment modality to older age and with comorbidities. Nowadays, there are several treat- ment options for patients with MDS but the definite indications for early HCT are limited to the group of patients with IPSS intermediate-2 and high. Nevertheless, newer prognostic model scoring should be taken under consideration, as probable indications for early HCT emerge. The type of transplant has to be defined and individualized according to the disease status, patient general condition and co- morbidities. Every patient up to 60-65 years with MDS should not be referred for transplant, but patients presented with advanced disease or are transfusion dependent and do not have del(5q) should probably be transplanted. Patient preference remains a critical issue in the decision making. Current non transplant therapeutic interventions remain inadequate to supplant transplantation which offers long-term survival rates of between 25% and 70% with acceptable toxicity.