Canterbury DHB
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When considering the decision whether or not to recommend allogeneic transplantation the benefits, risks and alternative treatments must be considered as well as the natural history of MDS if untreated. In New Zealand as of May 2014 there is no alternative treatment which modifies the natural history of MDS and until novel agents, i.e. hypomethylating agents and iMIDs, are funded best supportive care remains the only treatment for non-transplant eligible patients.
The prognosis of the patient should be considered using one of the validated scoring systems, e.g. IPSS and cytogenetic profile. Monosomal karyotype predicts a very poor prognosis.
Allografting should be considered in younger patients up to 60 years and with IPSS scores of INT-2 or higher. Transplant mortality remains high even if sibling donors are used (around 30-40%). Conventional myeloablative allografts should be considered for younger patients. There is insufficient evidence to recommend pre-transplant induction chemotherapy in all patients.
Autologous SCT should only be considered in the context of a clinical trial.
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Topic Code: 8156
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