This protocol addresses a clearly defined patient group: individuals aged 70 or younger who have higher-risk myelodysplastic syndrome — IPSS-R score of 4.0 or above — with no major comorbidities and with an HLA-identical or matched unrelated stem cell donor available.
Higher-risk MDS encompasses patients with IPSS-R ≥4.0, covering the high- and very high-risk groups as well as remaining intermediate-risk patients in that range. The combination of age 70 or younger, absence of major comorbidities, and donor availability defines the subgroup for whom allogeneic transplantation should be proposed according to current evidence. Age is a central eligibility criterion: most MDS patients are older than 70, making this subgroup a distinct and actionable population.
For this population, allogeneic stem cell transplantation (allo-SCT) is the treatment approach considered — it is regarded as the only potentially curative option. Whether any pre-transplant intervention is used, and under what conditions, depends on specific marrow findings at the time of evaluation. The full sequencing, criteria, and protocol details are available in the structured regimen.
DOI: 10.1016/j.annonc.2020.11.002
'Higher-risk' MDS includes patients with IPSS-R 4.0, i.e. high- and very high-risk, and the remaining intermediate-risk IPSS-R patients.
Allo-SCT should be proposed to all higher-risk MDS patients <70 years old without major comorbidities and with a donor [I, A].
Fit patients of 70 years (or sometimes slightly older if very fit) with a donor for allo-SCT.
allo-SCT remains the only potentially curative treatment of higher-risk MDS patients [I, A], but its major obstacle is age as most MDS patients are >70 years.
It is debated whether treatment aimed at reducing the blast count should be carried out before allo-SCT with AML-like ChT or HMAs. This is generally considered when marrow blasts are >10%, especially for non-myeloablative allo-SCT [III, A].
Reducing the marrow blast count before allo-SCT with AML-like ChT or HMAs is generally considered when marrow blasts are 10%, especially for non-myeloablative allo-SCT [III, A].
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