title: Diagnostic tools in the indications for allogeneic stem cell transplantation in myelodysplastic syndromes.
abstract: The rates of allogeneic stem cell transplantation (SCT) to treat the myelodysplastic syndromes (MDS) is continually increasing. However, given the growing arsenal of therapeutic options in parallel to deeper insight into the heterogeneity of this disorder, determining the indications for SCT in MDS remains a difficult task. The International Prognostic Scoring System (IPSS) serves as a guideline for therapeutic decisions, but many aspects (eg, interpretation of rare cytogenetic abnormalities, combinations of chromosomal alterations and/or molecular markers, variant clinical courses within distinct biological subgroups) remain the subject of continuous investigation. In an effort to achieve a more well-differentiated risk categorization, attempts have been made to perform a more detailed cytogenetic categorization, and the use of various fluorescein in situ hybridization (FISH) techniques has improved the description of aberrations. Multicenter initiatives have standardized multiparameter flow cytometry techniques for diagnosis of MDS. In advanced MDS, screening for molecular mutations can identify cases with a high transformation risk. Finally, the new World Health Organization classification system provides a more homogenous morphological categorization of MDS compared with the former French-American-British system. Consequently, in the near future, risk stratification in MDS might incorporate additional diagnostic tools and categorization systems aimed at improving the timing and indication for SCT in this complex disorder.
authors.affiliation: Interdisciplinary Clinic for Stem Cell Transplantation, University Cancer Center Hamburg, Hamburg, Germany. u.bacher@uke.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: Bacher
authors.forename: Claudia
authors.initials: C
authors.lastname: Haferlach
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
authors.forename: Susanne
authors.initials: S
authors.lastname: Schnittger
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Kern
authors.forename: Bettina
authors.initials: B
authors.lastname: Wiedemann
authors.forename: Axel Rolf
authors.initials: AR
authors.lastname: Zander
authors.forename: Torsten
authors.initials: T
authors.lastname: Haferlach
mesh_terms: D002869:Chromosome Aberrations / Q000145:classification; D020732:Cytogenetic Analysis / Q000379:methods; D004252:DNA Mutational Analysis / Q000379:methods; D005434:Flow Cytometry / Q000379:methods; D006801:Humans; D017404:In Situ Hybridization, Fluorescence / Q000379:methods; D009190:Myelodysplastic Syndromes / Q000145:classification / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D033581:Stem Cell Transplantation; D014184:Transplantation, Homologous; D014944:World Health Organization