Personalized allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes: Integrating molecular risk, donor selection, and post-transplant strategies.

Authors

Yu Wang, Xumeng Zhao, Mi Zhou, Yi Xiao

Published in

Cell transplantation. Volume 35. Pages 9636897261499610. Epub Oct 18, 2026.

Abstract

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains the only treatment with curative potential for myelodysplastic syndromes (MDS). This review synthesizes MDS-specific evidence on transplant indication and timing, conditioning, donor choice, molecular predictors, and post-transplant surveillance. Prospective biologic-assignment studies support a survival benefit in fit older adults with higher-risk MDS. The Molecular International Prognostic Scoring System (IPSS-M), transplant-specific cytogenetic and mutational factors, comorbidity, and transfusion burden refine selection beyond the Revised International Prognostic Scoring System (IPSS-R). Alternative donors expand access, including haploidentical transplantation with post-transplant cyclophosphamide. Conditioning intensity should reflect both disease risk and patient fitness, with regimen-level scoring emerging for cord blood transplantation. Although non-relapse mortality has decreased over time, relapse remains the major unresolved cause of failure. MDS-specific measurable residual disease, graft-versus-host disease, cytomegalovirus assessment, and risk-adapted post-transplant interventions provide a practical framework for individualized care.

PMID:
42893434
Bibliographic data and abstract were imported from PubMed on 18 Oct 2026.

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