All patients with myelodysplastic syndrome (MDS) should initially be considered for transplantation, according to Thomas Prebet, MD, PhD. Several factors can influence a final decision to transplant. Age is a primary consideration, including both chronological age and physiological age, notes Prebet. MDS is a heterogeneous disease and not all of the myelodysplastic syndromes will evolve at the same speed or with the same consequences, he explains. To help determine their appropriateness for transplantation, patients should be stratified into low risk and high risk for progression to acute myeloid leukemia. The measure often used to stratify patients is the Revised International Prognostic Scoring System (IPSS-R), which is aligned with the new cytogenetic classification. Prebet describes this measure as a more precise way to classify patients than the original IPSS. Once stratified, the general approach is to consider transplantation in patients with a low risk of progression only in the later stages of disease, and to strongly consider transplantation earlier for patients at high risk.

Patients with MDS are typically 60 years or older, making it necessary to evaluate them for comorbidities. The potential impact of comorbidities on a patient before, during, or after transplantation must be a part of the decision process. Another important consideration is how likely a patient is to adhere to a medication regimen. Therefore, a comprehensive evaluation is necessary to properly assess whether a patient is physically and emotionally fit for transplantation.