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Allogeneic Hematopoietic Cell Transplantation in Older Patients with Myelodysplastic Syndrome

From the Fred Hutchinson Cancer Research Center and the University of Washington, Seattle, WA

Author disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to H. Joachim Deeg, MD, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, D1-100, Seattle, WA 98109-1024; e-mail: jdeeg{at}fhcrc.org

Overview: Allogeneic hematopoietic cell transplantation (HCT) offers potentially curative therapy and long-term survival to patients with myelodysplastic syndrome (MDS). However, HCT is associated with a risk of treatment-related early mortality — particularly in patients with comorbid concerns, which are frequent in older individuals. Reduced-intensity conditioning regimens have lowered the mortality rates but appear to be associated with a higher incidence of relapse than observed with more intensive regimens. Disease stage and comorbid conditions, along with graft-versus-host disease (GVHD), are the major determinants of HCT outcome. Counseling of older patients should be individualized, focusing on those issues. Clearly, some patients with MDS in their 60s and even 70s do well and are cured with HCT.