Hematopoietic stem cell transplantation (HSCT) is the only curative therapy for patients with myelodysplastic syndrome (MDS). However, the morbidity and mortality associated with conventional HSCT have traditionally prevented many patients from undergoing such treatment. Recent advances, including better prognostic algorithms, the introduction of reduced intensity conditioning regimens, and experience with alternative donors, have made HSCT a realistic option for an increasing number of patients with MDS.