Stem cell transplantation in myelodysplastic syndromes.

The cornerstone of therapeutic management for most patients with myelodysplastic syndrome (MDS) is supportive care, mainly in view of the average advanced age in MDS and the poor response to therapy. Due to the lack of satisfactory therapies, allogeneic stem cell transplantation is today the treatment of choice in the majority of young patients with histocompatible siblings. Results of treatment with allogeneic stem cell transplantation varies considerably depending on the stage of disease at transplantation and various clinical factors, such as the presence of cytogenetic abnormalities, age, and the percentage of blasts in the bone marrow at transplantation. Most patients may benefit optimally from an allogeneic stem cell transplantation when the transplant is performed as soon as an HLA-identical family member has been identified. Progression to more advanced leukaemic conditions will be associated with a higher failure rate mainly due to an increased incidence of relapse after transplantation. Delay of the transplant may be justified in a minority of patients with refractory anaemia without cytopenias or complex cytogenetic abnormalities. Patients who lack an HLA-identical family donor may be transplanted with either autologous stem cells or alternative allogeneic donors. The results are less compared to those obtained with histocompatible sibling transplantation due to an increased risk of relapse after autologous stem cell transplantation or a higher treatment-related mortality after transplantation with genotypically non-identical donors.