Hematopoietic stem cell transplantation in myelodysplastic syndromes

Conventional Treatment: Myelodysplastic syndromes are hematopoietic stem cell disorders characterized by peripheral cytopenia, hypercellular bone marrow with dysplastic cell morphology and a tendency to evolve into acute myeloid leukemia. Supportive treatment with transfusions, antimicrobial agents, hematopoietic growth factors and conventional chemotherapy has only palliative character. Allogeneic Transplantation: Allogeneic hematopoietic stem cell transplantation from HLA-matched family or unrelated donors is currently the only potentially curative therapy. Outcome is determined by disease-, patient- and treatment-related features, which will be discussed in this review. Autologous Transplantation: Autologous transplantation is an alternative approach for patients which lack a suitable allogeneic stent cell donor. Autografts should be harvested in complete remission after intensive chemotherapy. Reduced treatment-related mortality is accompanied by increased risk of relapse. Future Directions: Clinical trials are currently evaluating dose-modified preparative regimens with decreased toxicity, which offer transplantation options also to older patients or patients with comorbidities.