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Allogeneic Stem Cell Transplantation for MDS

  • Bart L. Scott
  • M. Robin
Chapter
Part of the Hematologic Malignancies book series (HEMATOLOGIC)

Abstract

Allogeneic stem cell transplantation (SCT) is the only therapy with curative potential for myelodysplastic syndromes (MDS). However, there is substantial risk of treatment-related mortality (TRM) with SCT approximately 20% in the first year. Additionally, many patients with MDS are not candidates for SCT due to advanced age or comorbidities. Therefore, the appropriate selection of who to transplant and when to transplant is a key question that must be addressed. Additional questions include the optimal conditioning regimen prior to SCT and what therapy if any patients should receive prior to starting planned conditioning regimens. Retrospective comparative analyses have shown that there is a gain in life expectancy with SCT when MDS patients have Int-2 or high-risk disease by IPSS or intermediate, poor, or very poor risk disease by R-IPSS. To date, there are no randomized trials evaluating the optimal timing of SCT in MDS. Relapse remains the main cause of failure for SCT and novel conditioning regimens, and post-SCT prophylactic approaches are needed. While SCT may be the only cure for MDS, it is with significant risk, and careful consideration should be given to who will optimally benefit from this approach.

Keywords

Myelodysplastic syndromes Stem cell transplantation IPSS score Cytogenetic risk group Relapse Organ toxicity Comorbid conditions 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Fred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.University of WashingtonSeattleUSA
  3. 3.Saint-Louis Hospital, APHPParisFrance
  4. 4.INSERM 1131Paris 7 UniversityParisFrance

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