Intensive Chemotherapy Followed by Stem Cell Transplantation for the Treatment of Myelodysplastic Syndromes

Most patients with MDS are treated with supportive care only, mainly in view of the average advanced age in MDS and the poor response to more intensive therapy. Allogeneic stem cell transplantation is today the treatment of choice in the majority of young patients with histocompatible siblings. The results of treatment with allogeneic stem cell transplantation depend on the stage of disease at the time of transplantation and various clinical factors, such as the presence of cytogenetic abnormalities, age, and the percentage of blasts in the bone marrow at time of 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 leukemic conditions is 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 anemia without cytopenias or complex cytogenetic abnormalities.