Transplants in Myelodysplastic Syndromes

Myelodysplastic syndromes are one of the most common hematological disorders in the elderly. Therefore, an increase in the prevalence of de novo but also of secondary forms after prior chemotherapy or radiotherapy, respectively, is anticipated within the next years. Allogeneic stem cell transplantation is considered the only potentially curable therapy, but many patients are not eligible because of age or comorbidities. Reduced-intensity conditioning regimens have improved early tolerability of the procedure, although late effects remain a challenge in the care of these patients. However, hypomethylating agents have become available as alternative therapeutic approaches with a moderate toxicity profile.

Finally, should transplantation be a potential curative option in elderly patients with MDS? Yes it should be, but within prospective trials investigating the success of allogeneic SCT compared with other treatment options. In the absence of prospective trials, a careful individual selection should be done; patients should be stratified according to comorbidities, performance status, and disease risk. Chronic GVHD and relapse are still the major challenges after SCT. Therefore, special attention should be paid to posttransplant care in terms of GVHD management, MRD monitoring, and prevention of relapse.

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