Stem cell transplantation for myelodysplastic syndromes: the lure of a cure

Allogeneic stem cell transplantation is the only known curative therapy for myelodysplastic syndromes. However, the morbidity and mortality from this approach is high, especially in a population that tends to be elderly with comorbid conditions. In order to achieve a good outcome, the key is wise choice of the patient to undergo transplantation and appropriate timing of the therapy. Furthermore, consideration should be given to choosing whether the regimen should be fully myeloablative or reduced-intensity and whether marrow, peripheral-blood stem cells, or cord blood should be chosen for stem cell replacement. This article reviews the history of transplantation for this indication and the newer data driving decisions regarding the type of transplant and the optimal timing for best results.