The role of hematopoietic cell transplantation as therapy for myelodysplasia

A recent American Society of Blood and Marrow Transplantation (ASBMT) position paper concluded that allogeneic hematopoietic cell transplantation (HCT) is recommended for patients with myelodysplastic syndromes (MDS) with an International Prognostic Scoring System (IPSS) score of INT-2 at diagnosis who have a suitable donor and meet the transplant center's eligibility criteria and for selected patients at low risk at diagnosis who have poor prognostic features not included in the IPSS. While the ASBMT position is generally reasonable, given available data, physicians caring for MDS patients should be aware of the limitations of these conclusions. The position of the ASBMT is largely based on studies relying on the IPSS, which is imprecise, only applies to patients at diagnosis, ignores the impact of recent therapeutic advances, excludes patients with treatment-related MDS and certain subtypes of chronic myelomonocytic leukemia (CMML), and does not consider the influence of age and comorbidities on the decision-making process. The development of a revised IPSS for MDS provides us with an opportunity to reconsider the role of HCT in the treatment of MDS.