Allogeneic Sct In

Various therapeutic options exist for the management of a newly diagnosed patient with MDS. In addition to the subtype and IPSS score at diagnosis, the age and performance status of the patient are important determinants of feasible therapeutic options. In spite of significant improvements in supportive care and the increasing therapeutic options that are available (Chapter 44 and 48), an allogeneic SCT remains the only option that has curative potential, leading to the recommendation that all patients who are eligible for a transplant procedure and have an available donor should be considered for this procedure.10 However, in reality this therapeutic option is limited to a small fraction of patients with this diagnosis, as the majority of patients are over 65 years, with additional comorbidities and poor performance status. Even when other adverse factors are not present, this group of older patients is perceived as being unable to tolerate a standard myeloab-lative conditioning regimen.

Since MDS has significant variability in the natural history and response to therapy, no single therapeutic algorithm can be applied to this group of patients; rather, therapy has to be tailored to the individual patient. For patients eligible to undergo an allogeneic SCT, the factors that have a bearing on transplant outcome have to be weighed against the risks involved. In this chapter we look at some of these factors and provide a broad overview of the role of an allogeneic SCT in the management of MDS.

0 0

Post a comment