Timing and Candidacy for AlloHSCT in MDS

Summary for Physicians:

AlloHSCT is considered for patients with MDS who are classified as having higher-risk disease. The decision is guided by several key factors, as follows:

• Risk stratification tools, such as the Revised International Prognostic Scoring System, are used to identify patients with intermediate-, high-, or very high-risk MDS who may benefit from transplant.

• Cytogenetic and molecular features play a significant role, with poor-risk abnormalities (eg, TP53 mutations, complex karyotype) supporting the need for early transplant consideration.

• Clinical trajectory, including rapid disease progression, rising transfusion requirements, and worsening cytopenias can influence timing and urgency.

In general, alloHSCT is pursued in patients with a poor prognosis where curative intent outweighs transplant-related risks.

Nelli Bejanyan reports consulting or advisory role for CareDx, Medexus Pharmaceuticals, Orca Biosystems, AlloVir, TScan Therapeutics, and Pfizer; and research funding from CRISPR Therapeutics. Everett Meyer reports sponsored research from Orca Biosciences, Kyverna; and a scientific advisor role and equity holder for GigaMune, Indee, TRACT, Jura Biosciences.Caspian Oliai reports no relevant disclosures (investigator on the Orca T trial funded by Orca Biosciences). Arpita P. Gandhi reports roles with OncLive, MJH Life Sciences, OrcaBio (research), CareDx (Advisory Board). Amandeep Salhotra reports received funding from Rigel, Bristol Myers Squibb and Orca Biosciences; and speakers bureau for Incyte and Sanofi.