National Trends and In-Hospital Outcomes of Hematopoietic Stem Cell Transplant in Myelodysplastic Syndromes, 2016–2020

Background: Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative therapy for patients with myelodysplastic syndromes (MDS). Despite comparable outcomes in older adults, disparities in HSCT utilization persist. This study analyzes trends, outcomes, and barriers such as age and insurance status associated with HSCT in MDS. Methods: We performed a retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2020 using ICD-10 codes to identify adult patients undergoing allogeneic HSCT. Patients were stratified by MDS diagnosis. National estimates were calculated using discharge weights. Baseline characteristics and outcomes were compared using Pearson Chi-square and t-tests. Propensity score matching adjusted for confounders. Results: Among 30,460 patients who underwent allogeneic HSCT, 4,980 (16.16%) had MDS. MDS patients were older (median age 62 vs. 49 years, p<0.001) and had more comorbidities, including chronic lung disease, diabetes, and hypertension (p<0.001). They were more likely to have Medicare (38.73% vs. 17.10%) and less likely to have private insurance (50.80% vs. 56.96%, p<0.001). From 2016 to 2020, the proportion of MDS patients receiving HSCT increased from 13.20% to 17.32% before a slight decline in 2020. MDS patients had higher in-hospital mortality (aOR 1.33, 95% CI 1.14–1.55), mechanical ventilation (aOR 1.30), neutropenic fever (aOR 1.20), and acute GVHD (aOR 1.26), but lower Clostridium difficile infection (aOR 0.75). Conclusion: MDS patients undergoing allogeneic HSCT are older, carry greater comorbidity burdens, and have worse in-hospital outcomes. Insurance disparities and age may remain barriers despite increasing utilization. Further research is needed to optimize selection and peri-transplant care.