Effect Of Time To Transplant From Diagnosis

While an allogeneic SCT is the only curative therapeutic option in the management of MDS, it is also associated with the highest TRM. NRM caused by infections, graft-versus-host disease (GVHD), and organ toxicity in large series of patients undergoing an allogeneic SCT varies from 30-54%.16'18'19 It would not be appropriate to expose low-risk MDS patients to these risks. However, MDS is for the most part a continuously evolving disease process with an inexorable progression to acute leukemia, and an allogeneic SCT done in a more advanced stage of the disease process is associated with significantly worse outcomes.78 The optimal time has been a matter of controversy, especially for the low- and intermediate-risk MDS. A recent publication by Cutler et al.20 attempted to address this issue by applying a statistical technique called a Markov model to predict long-term outcomes under conditions of uncertainty. In patients with low- or intermediate-risk MDS, delayed transplantation by a fixed time interval (2-2.5 years) and prior to leukemia transformation maximized overall survival. This survival advantage was even more prominent in patients younger than 40 years in this risk group. For intermediate 2 and the high-risk group, immediate transplantation improved overall survival.

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