HematopoieticCellTransplantation for Myelodysplastic Syndromes

摘要: Allogeneic hematopoietic cell transplantation (HCT) offers the only potential cure for patients with myelodysplastic syndromes (MDS). However, current approaches to HCT, many older comorbidities are poor HCT candidates, and treatmentrelated morbidity mortality may offset benefit lower-risk disease. Consequently, selection of MDS should take into consideration disease risk category including mutational status, comorbidity index, functional donor options, available institutional resources. Formal geriatric assessment further guide use and, if is chosen, conditioning intensity. Patients higher-risk be considered at time diagnosis, whereas expectant nontransplant management more appropriate those A high blastburden increases ofsubsequent relapse; however,the role pretransplant cytoreductive therapy regimen choice remain controversial. younger than 65 years an index # 4m ay from intense regimens. The presence complex or monosomal karyotype mutations in TP53, DNMT3A, other genes identify poorer outcomes following HCT. TP53 have particularly survival, enrolled clinical trials whenever possible. Several important studies ongoing will better define as well value post-transplant relapse-prevention strategies. Given apparentunderuseofHCTineligiblepatientsandlowenrollmentinMDSHCTclinicaltrials date, timely referral such programs critical.