Outcomes in patients undergoing hematopoietic stem cell transplantation for myelodysplastic syndromes.

Hematopoietic stem cell transplantation [HSCT] is the only curative option for patients with myelodysplastic syndromes [MDS]. Between 1991 and 2021, 154 patients [high risk, 86; low risk, 68] including 22 children underwent HSCT with a median age of 36 years. Conditioning regimens were myeloablative [n=97] and reduced intensity [n=53]. Donors were human leucocyte antigen (HLA)-matched related donors (MRDs) in 113 and alternate donors in 41. The graft source was peripheral blood stem cells in 92%. Engraftment occurred in 126 [81.9%] at a median of 15 days while 20 [12.9%] died before engraftment and eight [5.2%] had primary graft failure. Sinusoidal obstruction syndrome was seen in 27 [17.5%]. Grade 2-4 acute graft versus host disease [GVHD] occurred in 46.3% while Grade 3-4 GVHD was seen in 34.9% and the incidence of chronic GVHD was 69.4%. Bacterial infections occurred in 38 (24.6%) while viral infections were seen in 31 [20.1%], mainly cytomegalovirus, and invasive fungal disease in 17.5%. At a median of 33 months, 65 patients were alive; 14 (9.1%) had disease relapse, and 10 (6.5%) had secondary graft failure. The five-year overall survival (OS) (time from allogenic HSCT to death due to any cause) and event-free survival (time from allogenic HSCT to relapse/ progression of disease or death) were 41.69±4.2% and 40.8±4.4%, respectively. The five-year OS was significantly better in children [71%]. Outcomes were better with MRDs [45%] compared to alternate donors [29%;