CONVENTIONAL TREATMENT: Myelodysplastic syndromes are hematopoietic stem cell disorders characterized by peripheral cytopenia, hypercellular bone marrow with dysplastic cell morphology and a tendency to evolve into acute myeloid leukemia. Supportive treatment with transfusions, antimicrobial agents, hematopoietic growth factors and conventional chemotherapy has only palliative character.
Allogeneic transplantation: Allogeneic hematopoietic stem cell transplantation from HLA-matched family or unrelated donors is currently the only potentially curative therapy. Outcome is determined by disease-, patient- and treatment-related features, which will be discussed in this review.
Autologous transplantation: Autologous transplantation is an alternative approach for patients which lack a suitable allogeneic stem cell donor. Autografts should be harvested in complete remission after intensive chemotherapy. Reduced treatment-related mortality is accompanied by increased risk of relapse.
Future directions: Clinical trials are currently evaluating dose-modified preparative regimens with decreased toxicity, which offer transplantation options also to older patients or patients with comorbidities.