Around 40% of patients suffering from myelodisplastic syndromes can be cured by allogeneic bone marrow transplantations. The most favorable results are observed in patients with refractory anemia who present an event free survival of up to 65% at 5 years. The main restrictions in the application of this strategy for the majority of the patients are the advanced age of diagnosis and the availability of a compatible donor. The higher risk of relapse in patients with an increased rate of blasts and high-risk cytogenetic alterations mainly identified in secondary myelodisplastias further limit its use. Although some patients can be benefited by the utilization of pre-transplantation cytoreductive chemotherapy, there is still insufficient proof of a clear benefit for the majority of patients. Not one preparatory regime has shown to be superior, however the increased use of non-myeloablative regimes favor the treatment of a greater number of over 60-year-old patients. Preliminary studies also indicated that specific patients can be benefited by a autogenic transplantation and these results should be compared with those from unrelated donors. Recent studies also demonstrated more favorable results with the utilization of hematopoietic stem cells from peripheral blood in patients high risk of relapse. Better definition of prognostic factors will allow an ideal selection of patients and the optimal time for the procedure.
Myelodisplastic Syndrome; bone marrow transplantation