In this report from the European Society for Blood and Marrow Transplantation (EBMT), an international panel of experts present treatment guidelines for patients with myelodysplastic syndromes (MDS). Recommendations are classified into patient-related and disease-related factors, and focus on determining which factors can best identify hematopoietic cell transplantation (HCT) candidates.
Clinical factors identified as most relevant for decision-making include percentage of bone marrow myeloblasts and flow cytometric characteristics, cytogenetic and molecular characteristics, and cytopenias, including red blood cell transfusion dependence.
The report discusses several clinical factors that determine response to treatment modalities, including intensive chemotherapy (ICT), hypomethylating agents (HMA), immunomodulatory agents, such as lenalidomide, and hematopoietic growth factors.
Other topics addressed include optimal transplant timing and post-transplantation strategies to prevent relapse. The experts noted that delaying HCT for patients with lower risk disease maximized life expectancy, and recommended HCT when progression occurs in intermediate risk by the Revised International Prognostic Scoring System (IPSS-R) or intermediate risk by the WHO Classification-based Prognostic Scoring System (WPSS).
The panel concluded that the most relevant clinical variables for HCT eligibility are the IPSS-R and co-morbidity index (CI), graded according to the HCT-CI.