EHA Library - The official digital education library of European Hematology Association (EHA)

Indications for transplantation in myelodysplastic syndromes (MDS)
EHA Library. Della Porta M. 06/14/17; 185048 Topic: 2Ag Myelodysplastic syndromes
Matteo Giovanni Della Porta
Matteo Giovanni Della Porta
Contributions
Learning Objectives
Pierre Fenaux - Chair Introduction

The last years have seen breakthroughs in the pathophysiology of MDS, especially regarding somatic mutations observed in most MDS cases, and the frequent association between MDS and immune abnormalities. While treatment has improved, allogeneic SCT remains the only potentially curtative approach in MDS

J Jansen describes clonal progression in MDS, with the occurrence of new cytogenetic abnormalities or somatic mutations, driving more aggressive and dominant subclones that may ultimately lead to AML progression. Conversely, some subclones may be particularly sensitive to a given treatment, with disease regression to earlier MDS stage. The author also reports on the progression from clonal hematopoiesis of indeterminate potential (CHIP) to MDS

G Mufti reports on the immune abnormalities and immune disorders observed in MDS, a situation where it is often unclear if the former induces the latter or vice versa. Recent reports suggest in particular that an inflammatory microenvironment could contribute to the induction of MDS, while genetic abnormalities of MDS cells, and/or the fact that cells of the immune system may be part of the MDS clone could contribute to the development of immune abnormalities

Finally, L Malcovati reviews indications for allogeneic SCT in MDS. While transplant used to be restricted to higher risk MDS according to the classical IPSS, the advent of revised IPSS, the assessment of the somatic mutational profile (most mutations have a poor prognosis) and the impact of severe cytopenias is extending the indications to some IPSS lower risk MDS patients . Prospective studies are however required to validate those new indications

Learning Objectives of the manuscript
After viewing this presentation the participant will be able to:
- Somatic mutations are seen in most MDS, and their number increases during evolution, creating subclones that may compete with each other.
- Immune disorders are frequent in MDS, and it is not always clear if they are the cause or the consequence of MDS.
- Allogeneic SCT remains the only curative treatment of MDS. Its indications tend to extend to several types of lower MDS, based in particular on the revised IPSS, the presence of somatic mutations or the importance of cytopenias.

Learning Objectives of the presentation
After viewing this presentation the participant will be able to:
- Provide a basis to select candidate patients based on both disease and patient-related factors.
- Provide a basis to define optimal timing of transplantation in individual patient.
- Discuss the use of hypomethylating agents as part of a comprehensive strategy to prevent relapse after transplantation in high risk patients.
- Discuss the clinical utility of somatic mutations in MDS transplantation decision-making.

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