Allogeneic stem cell transplantation in MDS: how? When?

Allogeneic hematopoietic stem cell transplantation (allo-HCT) can cure a proportion of patients with myelodysplastic syndromes (MDS). However, MDS remains a disease of the elderly often being not eligible for intensive treatment approaches like allo-HCT. Further, recent new developments with innovative drugs including hypomethylating agents (HMA) have extended the therapeutic alternatives for our patients. Nevertheless, with the introduction of reduced-intensity conditioning and thereby reducing early mortality, transplant numbers in MDS patients have significantly increased recently. Notably, causes of late morbidity and mortality including graft versus host disease and relapse remain and challenge patient care. In the absence of prospective randomized trials emphasis should be put on patient selection and optimization of the pre- and post-transplant treatment in order to achieve long-term disease control and at the same time maintain an adequate quality of life.