Haematopoietic Stem Cell Transplantation in MDS for Adults

Chapter

Abstract

Myelodysplastic syndromes comprise a heterogeneous group of stem cell diseases. Different classification systems like the French American and British (FAB), the World Health Organization (WHO) and the International Prognostic Scoring System (IPSS) tried to differentiate the specific entities and envisage the prognosis. The spectrum is wide, including indolent diseases with a probability of survival over 10 years but on the other end patients rapidly progress to acute myeloid leukaemia and will die within a few months. However, most studies include different entities making difficult the clear interpretation of results. Most of the MDS patients are elder than 60 years. As life expectancy is increasing in the developed world the prevalence of MDS is increasing as well. Allogeneic haematopoietic stem cell transplantation is considered to be the only curative treatment for MDS but most patients are too old for myeloablative transplant. Moreover, patients over the age of sixty with the worst IPSS scores have the shortest life expectancy with standard care urging more effective treatment modalities. Younger patients with better IPSS scores may survive 5–10 years even with supportive treatment but these younger patients are those, who have the best transplant results and can be cured too. Unfortunately, with standard conditioning even these younger patients have a high probability of transplant related mortality of approximately 30–40%. Finally, it must be emphasized, that there are no large prospective studies comparing stem cell transplantation versus standard chemotherapy or supportive care in MDS. In consequence, the therapeutic decision making on stem cell transplantation is very difficult and debates are ongoing in the field.

Keywords

Acute GVHD Chronic GVHD Haematopoietic Stem Cell Transplantation International Prognostic Scoring System Reduce Intensity Conditioning 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media B.V. 2011

Authors and Affiliations

  1. 1.Department of Haematology and Stem Cell TransplantationSt. István and St. László Hospital of BudapestBudapestHungary

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