Hematopoietic stem cell transplantation in the myelodisplastic syndromes

Myelodisplastic syndromes (MDS) are clonal hematopoietic disorders, characterized by ineffective hemopoiesis resulting in single or multiple lineages and a high risk of conversion to acute leukemia. Currently, the only established therapy with curative potential for MDS is a hemopoietic stem cell transplant (HSCT). Their results are determined by the type of MDS, age at the BMT and the score according to the international index. In the main studies the disease-free survival (DFS) were 35-43%, relapse 20 to 39% and transplantation-related mortality (TRM) 36-45%. HSCT offers best results in goods prognosis MDS (refractory anemia, refractory anemia with ring sideroblasts) with DFS of 53-72% and 13% of relapse, in contrast with the advanced MDS (refractory anemia with blast in excess (AREB), AREB in transformation and secondary acute leukemia) where the DFS is about similar to 33%, the relapse 23-34% and MRT 37-60%. The HSCT from unrelated donor is an option for patients that do not an HLA-matched related donor, with a similar to 30% of DFS, but with a MRT up to 58%. The HSCT with regimens of low intensity (minitransplants) for aged patients are feasible but their efficacy has not yet been determined.