Optimal positioning of hematopoietic stem cell transplantation for older patients with myelodysplastic syndromes

Abstract

This review examines reduced-intensity conditioning (RIC) allogeneic hematopoietic stem cell transplantation (HSCT) for older patients (age ≥60 years) with myelodysplastic syndromes (MDS), focusing on how to choose candidates for HSCT as well as data on the comparative effectiveness of RIC HSCT versus other treatment approaches. For some older patients with MDS, there may be a survival advantage for RIC HSCT compared with nontransplantation approaches. Health service approaches suggest that optimal treatment choice varies with MDS risk. For those with low/intermediate-1 International Prognostic Scoring System (IPSS) risk, non-HSCT treatments may be preferred, but for intermediate-2/high IPSS patients, RIC HSCT may be better, even after adjusting for quality of life (QoL). The optimal positioning of HSCT for older patients with MDS is evolving. Available data suggest that for older patients with higher risk MDS, if their QoL is affected and they are medically fit, RIC HSCT may lead to more favourable outcomes. Prospective trials in older patients with MDS are necessary to confirm the putative benefit of RIC HSCT.