Optimal timing of allogeneic hematopoietic stem cell transplant in MDS

Myelodysplastic neoplasms (MDS) are clonal hematopoietic disorders characterized by ineffective hematopoiesis hematopoiesis: (hi-mat-uh-poy-EE-suss) The process of making blood cells in the bone marrow. , dysplasia, and a significant risk of progression to acute myeloid leukemia acute myeloid leukemia: (uh-KYOOT my-uh-LOYD loo-KEE-mee-uh) A cancer of the blood cells. It happens when very young white blood cells (blasts) in the bone marrow fail to mature. The blast cells stay in the bone marrow and become to numerous. This slows production of red blood cells and platelets. Some cases of MDS become… . Allogeneic hematopoietic stem cell transplant (HSCT) remains the only potentially curative therapy for MDS, particularly for higher-risk disease, but its success depends heavily on the timing of the procedure. This review explores the evolving evidence and decision models guiding the optimal timing of HSCT, balancing the risks of disease progression and transplant-related morbidity and mortality. Key considerations include advancements in disease-specific and transplant-specific risk stratification, such as the IPSS-M and transplant-specific scoring systems, which integrate clinical, cytogenetic, and molecular data to personalize timing decisions. Improvements in haploidentical HSCT and supportive care supportive care: Care given to improve the quality of life, or comfort, of a person with a chronic illness. Supportive care treats the symptoms rather than the underlying cause of a disease. The goal is to help the patient feel better. Patients with low blood counts may be given blood transfusions as supportive… have expanded the feasibility and safety of HSCT for diverse patient populations, including the elderly. Prospective trials underscore the survival benefits of HSCT over non-transplant approaches for higher-risk MDS, while ongoing studies aim to address uncertainties in pretreatment, post-transplant maintenance therapy, and donor selection. By synthesizing these developments, this review provides practical insights into optimizing HSCT timing to improve outcomes for MDS patients.