Considerations when planning hemopoietic cell transplantation in patients with myelodysplastic syndrome (MDS).
| Factor under Consideration . | Condition . | Approach/Regimen . | Advantage . | Disadvantage . |
|---|---|---|---|---|
| Abbreviations: MA, myeloablative; NMA/RIC, nonmyeloablative/reduced-intensity conditioning; NRM, non-relapse mortality; GVHD, graft-versus-host disease; CSP, cyclosporine; MMF, mycophenolate mofetil; DLI, donor lymphocyte infusion; PBPC, peripheral blood progenitor cells; “?” indicates a lack of studies that would provide definitive answers. | ||||
| Pre-Transplant | ||||
| Induction chemotherapy | < 5% marrow blasts | No induction | ||
| ≥ 5% marrow blasts | Induction | Less relapse? | More NRM? | |
| No induction | More relapse? | |||
| Co-morbidity | Low | MA conditioning? | Less relapse? | More NRM? |
| NMA/RIC conditioning? | Less NRM | More relapse? | ||
| High | NMA/RIC conditioning | Less NRM | More relapse? | |
| Age (years), | ≤ 65/60 | MA conditioning | Less relapse? | More NRM? |
| related/unrelated donor | > 65/60 | NMA/RIC conditioning | Less NRM | More relapse? |
| Transplantation | ||||
| Source of stem cells | < 5% marrow blasts (MA conditioning) | Marrow | Less GVHD | |
| All others | PBPC | Less relapse | More GVHD | |
| Post-Transplant | ||||
| GVHD prophylaxis | Related donor (NMA/RIC conditioning) | Short course (e.g., CSP + MMF [x 2/day]) | More graft-versus- leukemia effect | More GVHD |
| All others | Longer course (e.g., CSP + MMF [x 3/day]) | Less GVHD? | More relapse? | |
| High risk for relapse | Taper prophylaxis early? | Less relapse? | More GVHD | |
| Donor lymphocyte | High donor cell chimerism | No DLI | ||
| infusion (DLI) | Low donor cell chimerism (< 50%, day 28) | DLI | Full donor engraftment/ less relapse | GVHD |
| Factor under Consideration . | Condition . | Approach/Regimen . | Advantage . | Disadvantage . |
|---|---|---|---|---|
| Abbreviations: MA, myeloablative; NMA/RIC, nonmyeloablative/reduced-intensity conditioning; NRM, non-relapse mortality; GVHD, graft-versus-host disease; CSP, cyclosporine; MMF, mycophenolate mofetil; DLI, donor lymphocyte infusion; PBPC, peripheral blood progenitor cells; “?” indicates a lack of studies that would provide definitive answers. | ||||
| Pre-Transplant | ||||
| Induction chemotherapy | < 5% marrow blasts | No induction | ||
| ≥ 5% marrow blasts | Induction | Less relapse? | More NRM? | |
| No induction | More relapse? | |||
| Co-morbidity | Low | MA conditioning? | Less relapse? | More NRM? |
| NMA/RIC conditioning? | Less NRM | More relapse? | ||
| High | NMA/RIC conditioning | Less NRM | More relapse? | |
| Age (years), | ≤ 65/60 | MA conditioning | Less relapse? | More NRM? |
| related/unrelated donor | > 65/60 | NMA/RIC conditioning | Less NRM | More relapse? |
| Transplantation | ||||
| Source of stem cells | < 5% marrow blasts (MA conditioning) | Marrow | Less GVHD | |
| All others | PBPC | Less relapse | More GVHD | |
| Post-Transplant | ||||
| GVHD prophylaxis | Related donor (NMA/RIC conditioning) | Short course (e.g., CSP + MMF [x 2/day]) | More graft-versus- leukemia effect | More GVHD |
| All others | Longer course (e.g., CSP + MMF [x 3/day]) | Less GVHD? | More relapse? | |
| High risk for relapse | Taper prophylaxis early? | Less relapse? | More GVHD | |
| Donor lymphocyte | High donor cell chimerism | No DLI | ||
| infusion (DLI) | Low donor cell chimerism (< 50%, day 28) | DLI | Full donor engraftment/ less relapse | GVHD |