Optimizing Timing and Preparation for Allogeneic Hematopoietic Stem Cell Transplantation in Higher-Risk Myelodysplastic Syndromes

This retrospective study evaluated allo-HSCT outcomes in 70 higher-risk MDS patients classified by the IPSS-R. Key factors analyzed included the interval from diagnosis to allo-HSCT (early: <6 months vs. late: ≥6 months), number of prior treatment cycles (less: <2 vs. more: ≥2), remission status (CR/PR vs. NR), and donor type (sibling vs. unrelated cord blood [UCB]). The results showed a significantly higher 3-year OS in the early HSCT group (70% vs. 50%, P = 0.05) with lower TRM (22.7% vs. 46.5%, P = 0.0205). Although more pre-transplant treatment cycles were linked to a lower relapse rate (2.3% vs. 15.4%, P = 0.0403), they did not significantly affect OS or TRM. Early HSCT emerged as the only significant factor influencing both OS (HR 2.84, P = 0.01) and TRM (HR 3.21, P = 0.01). While no significant differences were noted between sibling HSCT and UCB for OS and TRM, UCB demonstrated a lower incidence of chronic GVHD (19.0% vs. 52.9%, P = 0.003). Early allo-HSCT is recommended, with UCB as a viable alternative to sibling donors.