title: Should patients with high-risk or transformed myelodysplastic syndrome proceed directly to allogeneic transplant without prior cytoreduction by remission-induction chemotherapy or hypomethylating agent therapy?
abstract: The selection of a treatment strategy before allogeneic hematopoietic stem cell transplant (HSCT) for myelodysplastic syndrome is a delicate process. The expected relapse risk and nonrelapse mortality after HSCT and the response rates to the pretransplant strategies all play a role in this process. Fit patients younger than 60 to 65 years with > 10% marrow blasts and without high-risk cytogenetic abnormalities should be seriously considered for intensive chemotherapy (ICT) to reduce tumor load before HSCT. Other patients up to the age of 75 years may be considered for hypomethylating agent therapy before transplant. Patients with high-risk cytogenetic abnormalities should be treated in investigational protocols if they are not candidates for ICT.
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands. Electronic address: T.deWitte@ncmls.ru.nl.
authors.forename: Theo M
authors.initials: TM
authors.lastname: de Witte
authors.affiliation: St James's Institute of Oncology, Leeds, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Bowen
authors.affiliation: Hôpital St Louis, Paris, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Robin
authors.affiliation: Policlinica San Matteo, University of Pavia, Pavia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Malcovati
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Mufti
authors.affiliation: University Hospital Leipzig, Germany.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Centre Hospitalier Régional Universitaire de Lille, Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoubagha
authors.affiliation: University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D019175:DNA Methylation; D003657:Decision Making; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009190:Myelodysplastic Syndromes / Q000235:genetics / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
keywords: Allogeneic hematopoietic stem cell transplantation; Cytoreduction with hypomethylating agents; Cytoreduction with intensive chemotherapy; High-Risk myelodysplastic syndrome; Transformed myelodysplastic syndrome