Hematopoietic cell transplantation (HCT) is a curative therapy for patients with a diagnosis of myelodysplastic syndromes (MDS). The indications and the timing of HCT for MDS have remained controversial due to the high risk of morbidity and mortality related to this procedure. In view of the current evidence, for patients with an HLA-matched related donor with low and intermediate 1 IPSS, the best strategy is to delay transplantation, but to perform it prior to the development of acute myelogenous leukemia. For patients with intermediate 2 and high risk IPSS groups, transplantation soon after diagnosis confers the best prognosis. For patients lacking a HLA-matched related donor, studies involving a large number of patients with a long-term follow-up are needed to define the best option among conventional chemotherapy, autologous HCT or HCT from unrelated donors. For patients who are not candidates for myeloablative conditioning, prospective randomized trials are needed to define if non-myeloablative conditioning reduces the mortality not related to relapse without increasing the probability of relapse.
Hematopoietic cell transplant; myelodysplastic syndromes
