title: Allogeneic hematopoietic stem cell transplantation for MDS and CMML: recommendations from an international expert panel.
abstract: An international expert panel, active within the European Society for Blood and Marrow Transplantation, European LeukemiaNet, Blood and Marrow Transplant Clinical Trial Group, and the International Myelodysplastic Syndromes Foundation developed recommendations for allogeneic hematopoietic stem cell transplantation (HSCT) in myelodysplastic syndromes (MDS) and chronic myelomonocytic leukemia (CMML). Disease risks scored according to the revised International Prognostic Scoring System (IPSS-R) and presence of comorbidity graded according to the HCT Comorbidity Index (HCT-CI) were recognized as relevant clinical variables for HSCT eligibility. Fit patients with higher-risk IPSS-R and those with lower-risk IPSS-R with poor-risk genetic features, profound cytopenias, and high transfusion burden are candidates for HSCT. Patients with a very high MDS transplantation risk score, based on combination of advanced age, high HCT-CI, very poor-risk cytogenetic and molecular features, and high IPSS-R score have a low chance of cure with standard HSCT and consideration should be given to treating these patients in investigational studies. Cytoreductive therapy prior to HSCT is advised for patients with ≥10% bone marrow myeloblasts. Evidence from prospective randomized clinical trials does not provide support for specific recommendations on the optimal high intensity conditioning regimen. For patients with contraindications to high-intensity preparative regimens, reduced intensity conditioning should be considered. Optimal timing of HSCT requires careful evaluation of the available effective nontransplant strategies. Prophylactic donor lymphocyte infusion (DLI) strategies are recommended in patients at high risk of relapse after HSCT. Immune modulation by DLI strategies or second HSCT is advised if relapse occurs beyond 6 months after HSCT.
authors.affiliation: Department of Tumor Immunology, Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Theo
authors.initials: T
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: Department of Hematology and Bone Marrow Transplantation, Hôpital Saint-Louis/Assistance Publique-Hôpitaux de Paris (AP-HP)/University Paris 7, 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.identifier: 0000-0002-1460-1611
authors.initials: L
authors.lastname: Malcovati
authors.affiliation: Division of Hematology, Oncology, and Hemostasiology, University of Leipzig, Leipzig, Germany.
authors.forename: Dietger
authors.initials: D
authors.lastname: Niederwieser
authors.affiliation: Centre International de Recherche sur l'Inflammation de Lille, INSERM U995/Centre Hospitalier Universitaire/Université Lille 2, Lille, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yakoub-Agha
authors.affiliation: Department of Haematological Medicine, School of Medicine, Guy's, King's College and St. Thomas's Hospitals, London, United Kingdom.
authors.forename: Ghulam J
authors.initials: GJ
authors.lastname: Mufti
authors.affiliation: Service d'Hématologie Seniors, Hôpital Saint-Louis/AP-HP/University Paris 7, Paris, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Fenaux
authors.affiliation: Hospital Universitario La Fe, Valencia, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Sanz
authors.affiliation: Division of Clinical Hematology, Hematology Department, Hospital de la Santa Creu i Sant Pau/Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Rodrigo
authors.identifier: 0000-0001-5143-4042
authors.initials: R
authors.lastname: Martino
authors.affiliation: Clinica Ematologica, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy.
authors.forename: Emilio Paolo
authors.initials: EP
authors.lastname: Alessandrino
authors.affiliation: Hematology and Bone Marrow Transplantation Center, Fondazione IRCCS Ospedale Maggiore Policlinico/University of Milan, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onida
authors.affiliation: Hematology Division, Department of Internal Medicine, University of Patras Medical School, Patras, Greece.
authors.forename: Argiris
authors.initials: A
authors.lastname: Symeonidis
authors.affiliation: Hematology Division, Basel University Hospital, Basel, Switzerland.
authors.forename: Jakob
authors.initials: J
authors.lastname: Passweg
authors.affiliation: Medical Faculty, University Hospital Düsseldorf/Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Guido
authors.initials: G
authors.lastname: Kobbe
authors.affiliation: Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Hannover, Germany.
authors.forename: Arnold
authors.initials: A
authors.lastname: Ganser
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus, Dresden, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Platzbecker
authors.affiliation: Department of Medicine, Hematology, and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Jürgen
authors.initials: J
authors.lastname: Finke
authors.affiliation: Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Michel
authors.initials: M
authors.lastname: van Gelder
authors.affiliation: Department of Hematology, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands.
authors.forename: Arjan A
authors.initials: AA
authors.lastname: van de Loosdrecht
authors.affiliation: Karolinska University Hospital, Huddinge, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.affiliation: Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Stauder
authors.affiliation: Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland.
authors.forename: Liisa
authors.initials: L
authors.lastname: Volin
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, WA.|University of Washington, Seattle, WA.
authors.forename: H Joachim
authors.initials: HJ
authors.lastname: Deeg
authors.affiliation: Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Corey
authors.initials: C
authors.lastname: Cutler
authors.affiliation: Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Department of Stem Cell Transplant and Cellular Therapy, University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Richard
authors.initials: R
authors.lastname: Champlin
authors.affiliation: Adult Bone Marrow Transplant Service, Memorial Sloan Kettering Cancer Center, New York, NY.
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.affiliation: Moffitt Cancer Center, Tampa, FL; and.
authors.forename: Claudio
authors.initials: C
authors.lastname: Anasetti
authors.affiliation: Department for Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Nicolaus
authors.initials: N
authors.lastname: Kröger
mesh_terms: D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D015477:Leukemia, Myelomonocytic, Chronic / Q000628:therapy*; D009190:Myelodysplastic Syndromes / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012307:Risk Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous