FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2092755869> ?p ?o ?g. }

• W2092755869 endingPage "S8" @default.
• W2092755869 startingPage "S6" @default.
• W2092755869 abstract "Allogeneic stem cell transplantation is a potentially curative treatment for myelodysplastic syndromes. Transplants are clearly indicated in patients with intermediate-2 and high risk disease; there is controversy regarding when transplantation should be performed in patients with low and intermediate-1 risk disease. Most patients with MDS are over age 65 and Medicare has recently provisionally approved transplants, but only when performed as part of a comparative clinical trial which still must be finalized. Nonmyeloablative preparative regimens allow treatment of older patients with MDS, and novel approaches are under evaluation to reduce the risk of relapse and treatment related morbidity and mortality. Allogeneic stem cell transplantation is a potentially curative treatment for myelodysplastic syndromes. Transplants are clearly indicated in patients with intermediate-2 and high risk disease; there is controversy regarding when transplantation should be performed in patients with low and intermediate-1 risk disease. Most patients with MDS are over age 65 and Medicare has recently provisionally approved transplants, but only when performed as part of a comparative clinical trial which still must be finalized. Nonmyeloablative preparative regimens allow treatment of older patients with MDS, and novel approaches are under evaluation to reduce the risk of relapse and treatment related morbidity and mortality. Myelodysplastic syndromes (MDS) compose a family of clonal hematopoietic diseases characterized by bone marrow failure and a predisposition to evolve into acute myelogenous leukemia [1Hofmann W.K. Koeffler H.P. Myelodysplastic syndrome.Annu Rev Med. 2005; 56: 1-16Crossref PubMed Scopus (102) Google Scholar]. Despite the major progress in the understanding of the pathophysiology of MDS and recent advances in treatment, MDS remains an incurable disease with standard forms of treatment. The prognosis is related to the severity of pancytopenia, cytogenetic abnormalities, and percentage of bone marrow blasts. Prognostic indices have been developed based on these features [2Bernasconi P. Klersy C. Boni M. et al.World Health Organization classification in combination with cytogenetic markers improves the prognostic stratification of patients with de novo primary myelodysplastic syndromes.Br J Haematol. 2007; 137: 193-205Crossref PubMed Scopus (89) Google Scholar, 3Greenberg P. Cox C. LeBeau M.M. et al.International scoring system for evaluating prognosis in myelodysplastic syndromes.Blood. 1997; 89: 2079-2088Crossref PubMed Google Scholar, 4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar]. The widely used International Prognostic Scoring System (IPSS), developed in 1997, considers clinical features present only at diagnosis. Some are concerned that the IPSS undervalues the impact of adverse cytogenetics. MDS occurring after previous chemotherapy (treatment- or therapy-related MDS) is not considered in the IPSS system; this has a poor prognosis even when presenting with low-risk clinical features [4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar].Subsequent indices have tried to refine prognostic assessment, and the recently published M.D. Anderson scoring system can be applied anywhere during the treatment of the disease [4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar]. Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for MDS. HSCT is a high-risk procedure that carries substantial risks of treatment-related morbidity and mortality. MDS is largely a disease of the elderly, who often have comorbidities, and transplantation strategies must address the unique needs of this population.Results of Allogeneic HSCTAllogeneic HSCT is a potentially curative treatment for MDS. Results are related to the prognostic factors of the disease present at the time of transplantation. Patients with low-risk IPSS scores have the best results. The risks of relapse and treatment-related mortality are increased in patients with more advanced disease [5Anderson J.E. Appelbaum F.R. Fisher L.D. et al.Allogeneic bone marrow transplantation for 93 patients with myelodysplastic syndrome.Blood. 1993; 82: 677-681PubMed Google Scholar, 6Appelbaum F.R. Anderson J. Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score.Leukemia. 1998; 12: S25-S29Crossref PubMed Scopus (49) Google Scholar, 7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 8Locatelli F. Zecca M. Niemeyer C. et al.Role of allogeneic bone marrow transplantation for the treatment of myelodysplastic syndromes in childhood.Bone Marrow Transplant. 1996; 18: 63-68PubMed Google Scholar, 9Parmar S. de Lima M. Hematopoietic stem cell transplantation for myelodysplastic syndrome.Biol Blood Marrow Transplant. 2010; 16: S37-S44Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 10Warlick E.D. Cioc A. Defor T. et al.Allogeneic stem cell transplantation for adults with myelodysplastic syndromes: importance of pretransplant disease burden.Biol Blood Marrow Transplant. 2009; 15: 30-38Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar]. Prognosis is related to age, disease stage at transplantation, cytogenetics, and ferritin level [11Armand P. Kim H.T. Cutler C.S. et al.A prognostic score for patients with acute leukemia or myelodysplastic syndromes undergoing allogeneic stem cell transplantation.Biol Blood Marrow Transplant. 2008; 14: 28-35Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar]. Transplantation can be successfully performed in older patients who are in good general medical condition [7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 12McClune B.L. Weisdorf D.J. Pedersen T.L. et al.Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome.J Clin Oncol. 2010; 28: 1878-1887Crossref PubMed Scopus (371) Google Scholar]. HSCT has been most successful when the graft source is an HLA-matched related or unrelated donor [13Castro-Malaspina H. Harris R.E. Gajewski J. et al.Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program.Blood. 2002; 99: 1943-1951Crossref PubMed Scopus (197) Google Scholar, 14Deeg H.J. Storer B. Slattery J.T. et al.Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome.Blood. 2002; 100: 1201-1207Crossref PubMed Scopus (253) Google Scholar]; the success rate of HSCT with unrelated transplants now nearly approaches that of HSCT with matched sibling transplants.Allogeneic HSCT also is potentially curative for treatment-related MDS [15de Witte T. Hermans J. Vossen J. et al.Haematopoietic stem cell transplantation for patients with myelodysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).Br J Haematol. 2000; 110: 620-630Crossref PubMed Scopus (229) Google Scholar], with poor outcomes related to advanced age, cytogenetic abnormalities, lack of an HLA-identical donor, and transformation to AML [16Litzow M.R. Tarima S. Perez W.S. et al.Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia.Blood. 2010; 115: 1850-1857Crossref PubMed Scopus (164) Google Scholar]. The 5-year disease-free survival ranges from 50% in the presence of only 1 of these risk factors to 4% in the presence of all risk factors.Indications for HSCTThe indications for allogeneic HSCT are a matter of debate, given the risks of the procedure and the recent development of alternative therapeutic options. In 2004, Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] reported a decision analysis in MDS patients comparing the outcomes of HSCTs reported to the Center for International Blood and Marrow Transplantation Research with the outcomes of nontransplantation therapies from the IPSS analysis. They found that HSCT was associated with improved survival in patients with intermediate-2 and high-risk disease, whereas patients with low-risk and intermediate-1 MDS fared better with conservative care (ie, without allogeneic HSCT), given the relatively long natural history in this population. Patients with intermediate-2 and high-risk MDS, which is normally rapidly fatal, had improved survival with allogeneic HSCT. The decision analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] warrants reassessment, given the development of improved prognostic indices and advances in both HSCT and nontransplantation therapies, including hypomethylating agents and lenalidomide.Nonmyeloablative and Reduced-Intensity Preparative RegimensThe development of reduced-intensity preparative regimens has reduced the risk of treatment-related mortality in HSCT [18Champlin R. Khouri I. Shimoni A. et al.Harnessing graft-versus-malignancy: non-myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy.Br J Haematol. 2000; 111: 18-29Crossref PubMed Scopus (189) Google Scholar]. These regimens typically involve combinations of busulfan or melphalan with fludarabine [19de Lima M. Couriel D. Thall P.F. et al.Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS.Blood. 2004; 104: 857-864Crossref PubMed Scopus (354) Google Scholar, 20Nakamura R. Rodriguez R. Palmer J. et al.Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome.Bone Marrow Transplant. 2007; 40: 843-850Crossref PubMed Scopus (39) Google Scholar], those agents plus alemtuzumab [21Ho A.Y.L. Pagliuca A. Kenyon M. et al.Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning.Blood. 2004; 104: 1616-1623Crossref PubMed Scopus (184) Google Scholar, 22Lim Z.Y. Ho A.Y. Ingram W. Outcomes of alemtuzumab-based reduced-intensity conditioning stem cell transplantation using unrelated donors for myelodysplastic syndromes.Br J Haematol. 2006; 135: 201-209Crossref PubMed Scopus (47) Google Scholar], or low-dose total-body irradiation and fludarabine [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar]. The intensity of the regimen affects the risk of relapse of MDS. Relapse rates are higher with lower-intensity regimens, particularly in patients with advanced disease, although this effect is partially offset by a lower risk of treatment-related mortality [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar, 24de Lima M. Anagnostopoulos A. Munsell M. et al.Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation.Blood. 2004; 104: 865-872Crossref PubMed Scopus (328) Google Scholar, 25Martino R. Iacobelli S. Brand R. et al.Retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic hematopoietic stem cell transplantation using HLA-identical sibling donors in myelodysplastic syndromes.Blood. 2006; 108: 836-846Crossref PubMed Scopus (291) Google Scholar, 26Scott B.L. Sandmaier B.M. Storer B. et al.Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.Leukemia. 2006; 20: 128-135Crossref PubMed Scopus (210) Google Scholar].Integrating HSCT into the Overall Management of MDSA major question is when to perform allogeneic HSCT in patients presenting with low-risk or intermediate-1 risk MDS. Although the analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] indicated no advantage to early allogeneic HSCT, these patients ultimately have a fatal disease and have a better prognosis after transplantation compared with patients with more advanced MDS. The clinical and biological factors that indicate the need to proceed to transplantation remain to be defined. Patients with low-risk MDS have an indolent, but ultimately fatal disease. They are best treated conservatively at the time of diagnosis. Better criteria need to be defined for assessing prognosis [27Garcia-Manero G. Shan J. Faderl S. et al.A prognostic score for patients with lower-risk myelodysplastic syndrome.Leukemia. 2008; 22: 538-543Crossref PubMed Scopus (257) Google Scholar] and determining the optimum timing of HSCT in the course of the disease. Results are best when HSCT is performed without the presence of excess blasts and before the transformation to AML. Patients who fail to respond to hypomethylating agents or who lose their response have a relatively poor prognosis and might represent a category of patients in whom HSCT is indicated. Improved management of patients with advanced MDS is needed. Whether a trial of hypomethylating agent therapy will improve the outcome of subsequent allogeneic HSCT is unknown. Previous treatment with decitabine or azacitidine does not appear to increase the toxicity of the transplant [28De Padua Silva L. de Lima M. Kantarjian H. et al.Feasibility of allo-SCT after hypomethylating therapy with decitabine for myelodysplastic syndrome.Bone Marrow Transplant. 2009; 43: 839-843Crossref PubMed Scopus (72) Google Scholar].Medicare Insurance Coverage for MDSMedicare currently covers allogeneic HSCT for AML, but not for MDS, posing a major problem for these predominantly older patients with Medicare as their primary insurance. The Centers for Medicare and Medicaid Services recently recommended provisional approval with transplantation only as part of a national study comparing allogeneic HSCT and nontransplantation treatments. This trial is currently in the organizational stage; the design is challenging. Transplantation outcomes are routinely collected by the CIBMTR as part of the national Stem Cell Transplant Database. However, nontransplantation outcomes are not routinely reported to any single organization, and the analysis must adjust for known prognostic factors. There is likely a referral bias that patients being treated with hypomethylating agents are likely to continue that treatment when doing well and to be referred for HSCT if doing poorly.Approaches to Reduce RelapseNew preparative regimens that improve the eradication of MDS without increasing toxicity are needed. The use of novel agents, such as tresulfan, in preparative regimen, is currently being evaluated [29Hilgendorf I. Wolff D. Gromke T. et al.Retrospective analysis of treosulfan-based conditioning in comparison with standard conditioning in patients with myelodysplastic syndrome.Bone Marrow Transplant. 2010; Google Scholar]. Radioimmunotherapy, with the addition of a radiolabeled monoclonal antibody to CD45 to nonmyeloablative regimens, is a promising approach [30Pagel J.M. Gooley T.A. Rajendran J. et al.Allogeneic hematopoietic cell transplantation after conditioning with 131I-anti-CD45 antibody plus fludarabine and low-dose total body irradiation for elderly patients with advanced acute myeloid leukemia or high-risk myelodysplastic syndrome.Blood. 2009; 114: 5444-5453Crossref PubMed Scopus (131) Google Scholar].Another potential strategy is the use of posttransplantation maintenance therapy to prevent disease recrudescence. Hypomethylating agents have been shown to improve hematopoiesis and delay transformation to AML in the nontransplantation setting. de Lima et al. [31de Lima M. Giralt S. Thall P.F. et al.Maintenance therapy with low-dose azacitidine after allogeneic hematopoietic stem cell transplantation for recurrent acute myelogenous leukemia or myelodysplastic syndrome: a dose- and schedule-finding study.Cancer. 2010; Google Scholar] have evaluated the potential use of azacitidine after allogeneic HSCT. This promising approach is currently under study. Another major research direction is the modulation of graft-versus-malignancy effects through various measures.ConclusionAllogeneic HSCT is a potentially curative treatment for MDS. HSCT remains a high-risk treatment, however, and careful selection of patients is mandatory to ensure that this treatment approach is justified. Novel preparative regimens and posttransplantation treatment strategies are needed to reduce the risk of relapse. Continued improvements in supportive care are needed to prevent treatment-related morbidity and mortality in the generally older patients with MDS. Myelodysplastic syndromes (MDS) compose a family of clonal hematopoietic diseases characterized by bone marrow failure and a predisposition to evolve into acute myelogenous leukemia [1Hofmann W.K. Koeffler H.P. Myelodysplastic syndrome.Annu Rev Med. 2005; 56: 1-16Crossref PubMed Scopus (102) Google Scholar]. Despite the major progress in the understanding of the pathophysiology of MDS and recent advances in treatment, MDS remains an incurable disease with standard forms of treatment. The prognosis is related to the severity of pancytopenia, cytogenetic abnormalities, and percentage of bone marrow blasts. Prognostic indices have been developed based on these features [2Bernasconi P. Klersy C. Boni M. et al.World Health Organization classification in combination with cytogenetic markers improves the prognostic stratification of patients with de novo primary myelodysplastic syndromes.Br J Haematol. 2007; 137: 193-205Crossref PubMed Scopus (89) Google Scholar, 3Greenberg P. Cox C. LeBeau M.M. et al.International scoring system for evaluating prognosis in myelodysplastic syndromes.Blood. 1997; 89: 2079-2088Crossref PubMed Google Scholar, 4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar]. The widely used International Prognostic Scoring System (IPSS), developed in 1997, considers clinical features present only at diagnosis. Some are concerned that the IPSS undervalues the impact of adverse cytogenetics. MDS occurring after previous chemotherapy (treatment- or therapy-related MDS) is not considered in the IPSS system; this has a poor prognosis even when presenting with low-risk clinical features [4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar]. Subsequent indices have tried to refine prognostic assessment, and the recently published M.D. Anderson scoring system can be applied anywhere during the treatment of the disease [4Kantarjian H. O’Brien S. Ravandi F. et al.Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System.Cancer. 2008; 113: 1351-1361Crossref PubMed Scopus (407) Google Scholar]. Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative treatment for MDS. HSCT is a high-risk procedure that carries substantial risks of treatment-related morbidity and mortality. MDS is largely a disease of the elderly, who often have comorbidities, and transplantation strategies must address the unique needs of this population. Results of Allogeneic HSCTAllogeneic HSCT is a potentially curative treatment for MDS. Results are related to the prognostic factors of the disease present at the time of transplantation. Patients with low-risk IPSS scores have the best results. The risks of relapse and treatment-related mortality are increased in patients with more advanced disease [5Anderson J.E. Appelbaum F.R. Fisher L.D. et al.Allogeneic bone marrow transplantation for 93 patients with myelodysplastic syndrome.Blood. 1993; 82: 677-681PubMed Google Scholar, 6Appelbaum F.R. Anderson J. Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score.Leukemia. 1998; 12: S25-S29Crossref PubMed Scopus (49) Google Scholar, 7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 8Locatelli F. Zecca M. Niemeyer C. et al.Role of allogeneic bone marrow transplantation for the treatment of myelodysplastic syndromes in childhood.Bone Marrow Transplant. 1996; 18: 63-68PubMed Google Scholar, 9Parmar S. de Lima M. Hematopoietic stem cell transplantation for myelodysplastic syndrome.Biol Blood Marrow Transplant. 2010; 16: S37-S44Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 10Warlick E.D. Cioc A. Defor T. et al.Allogeneic stem cell transplantation for adults with myelodysplastic syndromes: importance of pretransplant disease burden.Biol Blood Marrow Transplant. 2009; 15: 30-38Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar]. Prognosis is related to age, disease stage at transplantation, cytogenetics, and ferritin level [11Armand P. Kim H.T. Cutler C.S. et al.A prognostic score for patients with acute leukemia or myelodysplastic syndromes undergoing allogeneic stem cell transplantation.Biol Blood Marrow Transplant. 2008; 14: 28-35Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar]. Transplantation can be successfully performed in older patients who are in good general medical condition [7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 12McClune B.L. Weisdorf D.J. Pedersen T.L. et al.Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome.J Clin Oncol. 2010; 28: 1878-1887Crossref PubMed Scopus (371) Google Scholar]. HSCT has been most successful when the graft source is an HLA-matched related or unrelated donor [13Castro-Malaspina H. Harris R.E. Gajewski J. et al.Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program.Blood. 2002; 99: 1943-1951Crossref PubMed Scopus (197) Google Scholar, 14Deeg H.J. Storer B. Slattery J.T. et al.Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome.Blood. 2002; 100: 1201-1207Crossref PubMed Scopus (253) Google Scholar]; the success rate of HSCT with unrelated transplants now nearly approaches that of HSCT with matched sibling transplants.Allogeneic HSCT also is potentially curative for treatment-related MDS [15de Witte T. Hermans J. Vossen J. et al.Haematopoietic stem cell transplantation for patients with myelodysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).Br J Haematol. 2000; 110: 620-630Crossref PubMed Scopus (229) Google Scholar], with poor outcomes related to advanced age, cytogenetic abnormalities, lack of an HLA-identical donor, and transformation to AML [16Litzow M.R. Tarima S. Perez W.S. et al.Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia.Blood. 2010; 115: 1850-1857Crossref PubMed Scopus (164) Google Scholar]. The 5-year disease-free survival ranges from 50% in the presence of only 1 of these risk factors to 4% in the presence of all risk factors. Allogeneic HSCT is a potentially curative treatment for MDS. Results are related to the prognostic factors of the disease present at the time of transplantation. Patients with low-risk IPSS scores have the best results. The risks of relapse and treatment-related mortality are increased in patients with more advanced disease [5Anderson J.E. Appelbaum F.R. Fisher L.D. et al.Allogeneic bone marrow transplantation for 93 patients with myelodysplastic syndrome.Blood. 1993; 82: 677-681PubMed Google Scholar, 6Appelbaum F.R. Anderson J. Allogeneic bone marrow transplantation for myelodysplastic syndrome: outcomes analysis according to IPSS score.Leukemia. 1998; 12: S25-S29Crossref PubMed Scopus (49) Google Scholar, 7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 8Locatelli F. Zecca M. Niemeyer C. et al.Role of allogeneic bone marrow transplantation for the treatment of myelodysplastic syndromes in childhood.Bone Marrow Transplant. 1996; 18: 63-68PubMed Google Scholar, 9Parmar S. de Lima M. Hematopoietic stem cell transplantation for myelodysplastic syndrome.Biol Blood Marrow Transplant. 2010; 16: S37-S44Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 10Warlick E.D. Cioc A. Defor T. et al.Allogeneic stem cell transplantation for adults with myelodysplastic syndromes: importance of pretransplant disease burden.Biol Blood Marrow Transplant. 2009; 15: 30-38Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar]. Prognosis is related to age, disease stage at transplantation, cytogenetics, and ferritin level [11Armand P. Kim H.T. Cutler C.S. et al.A prognostic score for patients with acute leukemia or myelodysplastic syndromes undergoing allogeneic stem cell transplantation.Biol Blood Marrow Transplant. 2008; 14: 28-35Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar]. Transplantation can be successfully performed in older patients who are in good general medical condition [7Deeg H.J. Shulman H.M. Anderson J.E. et al.Allogeneic and syngeneic marrow transplantation for myelodysplastic syndrome in patients 55 to 66 years of age.Blood. 2000; 95: 1188-1194PubMed Google Scholar, 12McClune B.L. Weisdorf D.J. Pedersen T.L. et al.Effect of age on outcome of reduced-intensity hematopoietic cell transplantation for older patients with acute myeloid leukemia in first complete remission or with myelodysplastic syndrome.J Clin Oncol. 2010; 28: 1878-1887Crossref PubMed Scopus (371) Google Scholar]. HSCT has been most successful when the graft source is an HLA-matched related or unrelated donor [13Castro-Malaspina H. Harris R.E. Gajewski J. et al.Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program.Blood. 2002; 99: 1943-1951Crossref PubMed Scopus (197) Google Scholar, 14Deeg H.J. Storer B. Slattery J.T. et al.Conditioning with targeted busulfan and cyclophosphamide for hemopoietic stem cell transplantation from related and unrelated donors in patients with myelodysplastic syndrome.Blood. 2002; 100: 1201-1207Crossref PubMed Scopus (253) Google Scholar]; the success rate of HSCT with unrelated transplants now nearly approaches that of HSCT with matched sibling transplants. Allogeneic HSCT also is potentially curative for treatment-related MDS [15de Witte T. Hermans J. Vossen J. et al.Haematopoietic stem cell transplantation for patients with myelodysplastic syndromes and secondary acute myeloid leukaemias: a report on behalf of the Chronic Leukaemia Working Party of the European Group for Blood and Marrow Transplantation (EBMT).Br J Haematol. 2000; 110: 620-630Crossref PubMed Scopus (229) Google Scholar], with poor outcomes related to advanced age, cytogenetic abnormalities, lack of an HLA-identical donor, and transformation to AML [16Litzow M.R. Tarima S. Perez W.S. et al.Allogeneic transplantation for therapy-related myelodysplastic syndrome and acute myeloid leukemia.Blood. 2010; 115: 1850-1857Crossref PubMed Scopus (164) Google Scholar]. The 5-year disease-free survival ranges from 50% in the presence of only 1 of these risk factors to 4% in the presence of all risk factors. Indications for HSCTThe indications for allogeneic HSCT are a matter of debate, given the risks of the procedure and the recent development of alternative therapeutic options. In 2004, Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] reported a decision analysis in MDS patients comparing the outcomes of HSCTs reported to the Center for International Blood and Marrow Transplantation Research with the outcomes of nontransplantation therapies from the IPSS analysis. They found that HSCT was associated with improved survival in patients with intermediate-2 and high-risk disease, whereas patients with low-risk and intermediate-1 MDS fared better with conservative care (ie, without allogeneic HSCT), given the relatively long natural history in this population. Patients with intermediate-2 and high-risk MDS, which is normally rapidly fatal, had improved survival with allogeneic HSCT. The decision analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] warrants reassessment, given the development of improved prognostic indices and advances in both HSCT and nontransplantation therapies, including hypomethylating agents and lenalidomide. The indications for allogeneic HSCT are a matter of debate, given the risks of the procedure and the recent development of alternative therapeutic options. In 2004, Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] reported a decision analysis in MDS patients comparing the outcomes of HSCTs reported to the Center for International Blood and Marrow Transplantation Research with the outcomes of nontransplantation therapies from the IPSS analysis. They found that HSCT was associated with improved survival in patients with intermediate-2 and high-risk disease, whereas patients with low-risk and intermediate-1 MDS fared better with conservative care (ie, without allogeneic HSCT), given the relatively long natural history in this population. Patients with intermediate-2 and high-risk MDS, which is normally rapidly fatal, had improved survival with allogeneic HSCT. The decision analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] warrants reassessment, given the development of improved prognostic indices and advances in both HSCT and nontransplantation therapies, including hypomethylating agents and lenalidomide. Nonmyeloablative and Reduced-Intensity Preparative RegimensThe development of reduced-intensity preparative regimens has reduced the risk of treatment-related mortality in HSCT [18Champlin R. Khouri I. Shimoni A. et al.Harnessing graft-versus-malignancy: non-myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy.Br J Haematol. 2000; 111: 18-29Crossref PubMed Scopus (189) Google Scholar]. These regimens typically involve combinations of busulfan or melphalan with fludarabine [19de Lima M. Couriel D. Thall P.F. et al.Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS.Blood. 2004; 104: 857-864Crossref PubMed Scopus (354) Google Scholar, 20Nakamura R. Rodriguez R. Palmer J. et al.Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome.Bone Marrow Transplant. 2007; 40: 843-850Crossref PubMed Scopus (39) Google Scholar], those agents plus alemtuzumab [21Ho A.Y.L. Pagliuca A. Kenyon M. et al.Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning.Blood. 2004; 104: 1616-1623Crossref PubMed Scopus (184) Google Scholar, 22Lim Z.Y. Ho A.Y. Ingram W. Outcomes of alemtuzumab-based reduced-intensity conditioning stem cell transplantation using unrelated donors for myelodysplastic syndromes.Br J Haematol. 2006; 135: 201-209Crossref PubMed Scopus (47) Google Scholar], or low-dose total-body irradiation and fludarabine [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar]. The intensity of the regimen affects the risk of relapse of MDS. Relapse rates are higher with lower-intensity regimens, particularly in patients with advanced disease, although this effect is partially offset by a lower risk of treatment-related mortality [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar, 24de Lima M. Anagnostopoulos A. Munsell M. et al.Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation.Blood. 2004; 104: 865-872Crossref PubMed Scopus (328) Google Scholar, 25Martino R. Iacobelli S. Brand R. et al.Retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic hematopoietic stem cell transplantation using HLA-identical sibling donors in myelodysplastic syndromes.Blood. 2006; 108: 836-846Crossref PubMed Scopus (291) Google Scholar, 26Scott B.L. Sandmaier B.M. Storer B. et al.Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.Leukemia. 2006; 20: 128-135Crossref PubMed Scopus (210) Google Scholar]. The development of reduced-intensity preparative regimens has reduced the risk of treatment-related mortality in HSCT [18Champlin R. Khouri I. Shimoni A. et al.Harnessing graft-versus-malignancy: non-myeloablative preparative regimens for allogeneic haematopoietic transplantation, an evolving strategy for adoptive immunotherapy.Br J Haematol. 2000; 111: 18-29Crossref PubMed Scopus (189) Google Scholar]. These regimens typically involve combinations of busulfan or melphalan with fludarabine [19de Lima M. Couriel D. Thall P.F. et al.Once-daily intravenous busulfan and fludarabine: clinical and pharmacokinetic results of a myeloablative, reduced-toxicity conditioning regimen for allogeneic stem cell transplantation in AML and MDS.Blood. 2004; 104: 857-864Crossref PubMed Scopus (354) Google Scholar, 20Nakamura R. Rodriguez R. Palmer J. et al.Reduced-intensity conditioning for allogeneic hematopoietic stem cell transplantation with fludarabine and melphalan is associated with durable disease control in myelodysplastic syndrome.Bone Marrow Transplant. 2007; 40: 843-850Crossref PubMed Scopus (39) Google Scholar], those agents plus alemtuzumab [21Ho A.Y.L. Pagliuca A. Kenyon M. et al.Reduced-intensity allogeneic hematopoietic stem cell transplantation for myelodysplastic syndrome and acute myeloid leukemia with multilineage dysplasia using fludarabine, busulphan, and alemtuzumab (FBC) conditioning.Blood. 2004; 104: 1616-1623Crossref PubMed Scopus (184) Google Scholar, 22Lim Z.Y. Ho A.Y. Ingram W. Outcomes of alemtuzumab-based reduced-intensity conditioning stem cell transplantation using unrelated donors for myelodysplastic syndromes.Br J Haematol. 2006; 135: 201-209Crossref PubMed Scopus (47) Google Scholar], or low-dose total-body irradiation and fludarabine [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar]. The intensity of the regimen affects the risk of relapse of MDS. Relapse rates are higher with lower-intensity regimens, particularly in patients with advanced disease, although this effect is partially offset by a lower risk of treatment-related mortality [23Laport G.G. Sandmaier B.M. Storer B.E. et al.Reduced-intensity conditioning followed by allogeneic hematopoietic cell transplantation for adult patients with myelodysplastic syndrome and myeloproliferative disorders.Biol Blood Marrow Transplant. 2008; 14: 246-255Abstract Full Text Full Text PDF PubMed Scopus (114) Google Scholar, 24de Lima M. Anagnostopoulos A. Munsell M. et al.Nonablative versus reduced-intensity conditioning regimens in the treatment of acute myeloid leukemia and high-risk myelodysplastic syndrome: dose is relevant for long-term disease control after allogeneic hematopoietic stem cell transplantation.Blood. 2004; 104: 865-872Crossref PubMed Scopus (328) Google Scholar, 25Martino R. Iacobelli S. Brand R. et al.Retrospective comparison of reduced-intensity conditioning and conventional high-dose conditioning for allogeneic hematopoietic stem cell transplantation using HLA-identical sibling donors in myelodysplastic syndromes.Blood. 2006; 108: 836-846Crossref PubMed Scopus (291) Google Scholar, 26Scott B.L. Sandmaier B.M. Storer B. et al.Myeloablative vs nonmyeloablative allogeneic transplantation for patients with myelodysplastic syndrome or acute myelogenous leukemia with multilineage dysplasia: a retrospective analysis.Leukemia. 2006; 20: 128-135Crossref PubMed Scopus (210) Google Scholar]. Integrating HSCT into the Overall Management of MDSA major question is when to perform allogeneic HSCT in patients presenting with low-risk or intermediate-1 risk MDS. Although the analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] indicated no advantage to early allogeneic HSCT, these patients ultimately have a fatal disease and have a better prognosis after transplantation compared with patients with more advanced MDS. The clinical and biological factors that indicate the need to proceed to transplantation remain to be defined. Patients with low-risk MDS have an indolent, but ultimately fatal disease. They are best treated conservatively at the time of diagnosis. Better criteria need to be defined for assessing prognosis [27Garcia-Manero G. Shan J. Faderl S. et al.A prognostic score for patients with lower-risk myelodysplastic syndrome.Leukemia. 2008; 22: 538-543Crossref PubMed Scopus (257) Google Scholar] and determining the optimum timing of HSCT in the course of the disease. Results are best when HSCT is performed without the presence of excess blasts and before the transformation to AML. Patients who fail to respond to hypomethylating agents or who lose their response have a relatively poor prognosis and might represent a category of patients in whom HSCT is indicated. Improved management of patients with advanced MDS is needed. Whether a trial of hypomethylating agent therapy will improve the outcome of subsequent allogeneic HSCT is unknown. Previous treatment with decitabine or azacitidine does not appear to increase the toxicity of the transplant [28De Padua Silva L. de Lima M. Kantarjian H. et al.Feasibility of allo-SCT after hypomethylating therapy with decitabine for myelodysplastic syndrome.Bone Marrow Transplant. 2009; 43: 839-843Crossref PubMed Scopus (72) Google Scholar]. A major question is when to perform allogeneic HSCT in patients presenting with low-risk or intermediate-1 risk MDS. Although the analysis of Cutler et al. [17Cutler C.S. Lee S.J. Greenberg P. et al.A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome.Blood. 2004; 104: 579-585Crossref PubMed Scopus (541) Google Scholar] indicated no advantage to early allogeneic HSCT, these patients ultimately have a fatal disease and have a better prognosis after transplantation compared with patients with more advanced MDS. The clinical and biological factors that indicate the need to proceed to transplantation remain to be defined. Patients with low-risk MDS have an indolent, but ultimately fatal disease. They are best treated conservatively at the time of diagnosis. Better criteria need to be defined for assessing prognosis [27Garcia-Manero G. Shan J. Faderl S. et al.A prognostic score for patients with lower-risk myelodysplastic syndrome.Leukemia. 2008; 22: 538-543Crossref PubMed Scopus (257) Google Scholar] and determining the optimum timing of HSCT in the course of the disease. Results are best when HSCT is performed without the presence of excess blasts and before the transformation to AML. Patients who fail to respond to hypomethylating agents or who lose their response have a relatively poor prognosis and might represent a category of patients in whom HSCT is indicated. Improved management of patients with advanced MDS is needed. Whether a trial of hypomethylating agent therapy will improve the outcome of subsequent allogeneic HSCT is unknown. Previous treatment with decitabine or azacitidine does not appear to increase the toxicity of the transplant [28De Padua Silva L. de Lima M. Kantarjian H. et al.Feasibility of allo-SCT after hypomethylating therapy with decitabine for myelodysplastic syndrome.Bone Marrow Transplant. 2009; 43: 839-843Crossref PubMed Scopus (72) Google Scholar]. Medicare Insurance Coverage for MDSMedicare currently covers allogeneic HSCT for AML, but not for MDS, posing a major problem for these predominantly older patients with Medicare as their primary insurance. The Centers for Medicare and Medicaid Services recently recommended provisional approval with transplantation only as part of a national study comparing allogeneic HSCT and nontransplantation treatments. This trial is currently in the organizational stage; the design is challenging. Transplantation outcomes are routinely collected by the CIBMTR as part of the national Stem Cell Transplant Database. However, nontransplantation outcomes are not routinely reported to any single organization, and the analysis must adjust for known prognostic factors. There is likely a referral bias that patients being treated with hypomethylating agents are likely to continue that treatment when doing well and to be referred for HSCT if doing poorly. Medicare currently covers allogeneic HSCT for AML, but not for MDS, posing a major problem for these predominantly older patients with Medicare as their primary insurance. The Centers for Medicare and Medicaid Services recently recommended provisional approval with transplantation only as part of a national study comparing allogeneic HSCT and nontransplantation treatments. This trial is currently in the organizational stage; the design is challenging. Transplantation outcomes are routinely collected by the CIBMTR as part of the national Stem Cell Transplant Database. However, nontransplantation outcomes are not routinely reported to any single organization, and the analysis must adjust for known prognostic factors. There is likely a referral bias that patients being treated with hypomethylating agents are likely to continue that treatment when doing well and to be referred for HSCT if doing poorly. Approaches to Reduce RelapseNew preparative regimens that improve the eradication of MDS without increasing toxicity are needed. The use of novel agents, such as tresulfan, in preparative regimen, is currently being evaluated [29Hilgendorf I. Wolff D. Gromke T. et al.Retrospective analysis of treosulfan-based conditioning in comparison with standard conditioning in patients with myelodysplastic syndrome.Bone Marrow Transplant. 2010; Google Scholar]. Radioimmunotherapy, with the addition of a radiolabeled monoclonal antibody to CD45 to nonmyeloablative regimens, is a promising approach [30Pagel J.M. Gooley T.A. Rajendran J. et al.Allogeneic hematopoietic cell transplantation after conditioning with 131I-anti-CD45 antibody plus fludarabine and low-dose total body irradiation for elderly patients with advanced acute myeloid leukemia or high-risk myelodysplastic syndrome.Blood. 2009; 114: 5444-5453Crossref PubMed Scopus (131) Google Scholar].Another potential strategy is the use of posttransplantation maintenance therapy to prevent disease recrudescence. Hypomethylating agents have been shown to improve hematopoiesis and delay transformation to AML in the nontransplantation setting. de Lima et al. [31de Lima M. Giralt S. Thall P.F. et al.Maintenance therapy with low-dose azacitidine after allogeneic hematopoietic stem cell transplantation for recurrent acute myelogenous leukemia or myelodysplastic syndrome: a dose- and schedule-finding study.Cancer. 2010; Google Scholar] have evaluated the potential use of azacitidine after allogeneic HSCT. This promising approach is currently under study. Another major research direction is the modulation of graft-versus-malignancy effects through various measures. New preparative regimens that improve the eradication of MDS without increasing toxicity are needed. The use of novel agents, such as tresulfan, in preparative regimen, is currently being evaluated [29Hilgendorf I. Wolff D. Gromke T. et al.Retrospective analysis of treosulfan-based conditioning in comparison with standard conditioning in patients with myelodysplastic syndrome.Bone Marrow Transplant. 2010; Google Scholar]. Radioimmunotherapy, with the addition of a radiolabeled monoclonal antibody to CD45 to nonmyeloablative regimens, is a promising approach [30Pagel J.M. Gooley T.A. Rajendran J. et al.Allogeneic hematopoietic cell transplantation after conditioning with 131I-anti-CD45 antibody plus fludarabine and low-dose total body irradiation for elderly patients with advanced acute myeloid leukemia or high-risk myelodysplastic syndrome.Blood. 2009; 114: 5444-5453Crossref PubMed Scopus (131) Google Scholar]. Another potential strategy is the use of posttransplantation maintenance therapy to prevent disease recrudescence. Hypomethylating agents have been shown to improve hematopoiesis and delay transformation to AML in the nontransplantation setting. de Lima et al. [31de Lima M. Giralt S. Thall P.F. et al.Maintenance therapy with low-dose azacitidine after allogeneic hematopoietic stem cell transplantation for recurrent acute myelogenous leukemia or myelodysplastic syndrome: a dose- and schedule-finding study.Cancer. 2010; Google Scholar] have evaluated the potential use of azacitidine after allogeneic HSCT. This promising approach is currently under study. Another major research direction is the modulation of graft-versus-malignancy effects through various measures. ConclusionAllogeneic HSCT is a potentially curative treatment for MDS. HSCT remains a high-risk treatment, however, and careful selection of patients is mandatory to ensure that this treatment approach is justified. Novel preparative regimens and posttransplantation treatment strategies are needed to reduce the risk of relapse. Continued improvements in supportive care are needed to prevent treatment-related morbidity and mortality in the generally older patients with MDS. Allogeneic HSCT is a potentially curative treatment for MDS. HSCT remains a high-risk treatment, however, and careful selection of patients is mandatory to ensure that this treatment approach is justified. Novel preparative regimens and posttransplantation treatment strategies are needed to reduce the risk of relapse. Continued improvements in supportive care are needed to prevent treatment-related morbidity and mortality in the generally older patients with MDS." @default.
• W2092755869 created "2016-06-24" @default.
• W2092755869 creator A5048913229 @default.
• W2092755869 date "2011-01-01" @default.
• W2092755869 modified "2023-09-27" @default.
• W2092755869 title "Hematopoietic Stem Cell Transplantation for Treatment of Myleodysplastic Syndromes" @default.
• W2092755869 cites W100647374 @default.
• W2092755869 cites W116615943 @default.
• W2092755869 cites W1487950379 @default.
• W2092755869 cites W1796660362 @default.
• W2092755869 cites W187238933 @default.
• W2092755869 cites W1971100781 @default.
• W2092755869 cites W1978659582 @default.
• W2092755869 cites W1983344261 @default.
• W2092755869 cites W1991125854 @default.
• W2092755869 cites W2000252768 @default.
• W2092755869 cites W2022794150 @default.
• W2092755869 cites W2024641723 @default.
• W2092755869 cites W2025428092 @default.
• W2092755869 cites W2026625631 @default.
• W2092755869 cites W2038581469 @default.
• W2092755869 cites W2062078763 @default.
• W2092755869 cites W2062506977 @default.
• W2092755869 cites W2078790776 @default.
• W2092755869 cites W2083163868 @default.
• W2092755869 cites W2087591188 @default.
• W2092755869 cites W2094994388 @default.
• W2092755869 cites W2103628120 @default.
• W2092755869 cites W2106947293 @default.
• W2092755869 cites W2131639268 @default.
• W2092755869 cites W2132469484 @default.
• W2092755869 cites W2136016420 @default.
• W2092755869 cites W2160820093 @default.
• W2092755869 cites W2164426492 @default.
• W2092755869 cites W2169668771 @default.
• W2092755869 cites W2412344548 @default.
• W2092755869 cites W3044574244 @default.
• W2092755869 doi "https://doi.org/10.1016/j.bbmt.2010.10.014" @default.
• W2092755869 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/21195312" @default.
• W2092755869 hasPublicationYear "2011" @default.
• W2092755869 type Work @default.
• W2092755869 sameAs 2092755869 @default.
• W2092755869 citedByCount "0" @default.
• W2092755869 crossrefType "journal-article" @default.
• W2092755869 hasAuthorship W2092755869A5048913229 @default.
• W2092755869 hasBestOaLocation W20927558691 @default.
• W2092755869 hasConcept C109159458 @default.
• W2092755869 hasConcept C126322002 @default.
• W2092755869 hasConcept C143998085 @default.
• W2092755869 hasConcept C2777408962 @default.
• W2092755869 hasConcept C28328180 @default.
• W2092755869 hasConcept C2911091166 @default.
• W2092755869 hasConcept C71924100 @default.
• W2092755869 hasConcept C86803240 @default.
• W2092755869 hasConcept C95444343 @default.
• W2092755869 hasConceptScore W2092755869C109159458 @default.
• W2092755869 hasConceptScore W2092755869C126322002 @default.
• W2092755869 hasConceptScore W2092755869C143998085 @default.
• W2092755869 hasConceptScore W2092755869C2777408962 @default.
• W2092755869 hasConceptScore W2092755869C28328180 @default.
• W2092755869 hasConceptScore W2092755869C2911091166 @default.
• W2092755869 hasConceptScore W2092755869C71924100 @default.
• W2092755869 hasConceptScore W2092755869C86803240 @default.
• W2092755869 hasConceptScore W2092755869C95444343 @default.
• W2092755869 hasIssue "1" @default.
• W2092755869 hasLocation W20927558691 @default.
• W2092755869 hasLocation W20927558692 @default.
• W2092755869 hasOpenAccess W2092755869 @default.
• W2092755869 hasPrimaryLocation W20927558691 @default.
• W2092755869 hasRelatedWork W2037749367 @default.
• W2092755869 hasRelatedWork W2046259286 @default.
• W2092755869 hasRelatedWork W2386230525 @default.
• W2092755869 hasRelatedWork W2394567568 @default.
• W2092755869 hasRelatedWork W2405332216 @default.
• W2092755869 hasRelatedWork W2414647507 @default.
• W2092755869 hasRelatedWork W2944683649 @default.
• W2092755869 hasRelatedWork W4302777402 @default.
• W2092755869 hasRelatedWork W2143290713 @default.
• W2092755869 hasRelatedWork W2164671137 @default.
• W2092755869 hasVolume "17" @default.
• W2092755869 isParatext "false" @default.
• W2092755869 isRetracted "false" @default.
• W2092755869 magId "2092755869" @default.
• W2092755869 workType "article" @default.