Allogeneic Stem Cell Transplantation
Allogeneic stem cell transplantation has been used to treat and sometimes cure patients with MDS. However, because of the high, sometimes life-threatening risks associated with stem cell transplantation, this treatment is mainly considered for
- Patients younger than age 60
- Patients up to age 75 who are in otherwise good health
- Patients who are in either the IPSS intermediate –2 or the IPSS high-risk category, or who have therapy-related (secondary) MDS (see International Prognostic Scoring System)
- Patients who have a human leukocyte-associated antigen (HLA)-matched stem cell donor (sibling or unrelated match).
Allogeneic stem cell transplants may also be considered for select lower-risk MDS patients with severe cytopenia. Autologous transplantation, using the patient’s own stem cells, is used in some other diseases but is not used in MDS since the patient’s own stem cells are abnormal because of the disease.
Graft Versus Host Disease. A serious risk of allogeneic stem cell transplantation is graft versus host disease(GVHD), which develops if the donor's immune cells attack your normal tissue. GVHD's effects can range from minor to life threatening.
Reduced-Intensity Allogeneic Stem Cell Transplantation
Patients who can't tolerate allogeneic transplantation with high-intensity chemotherapy may be eligible for reduced-intensity stem cell transplantation (sometimes called nonmyeloablative transplant).
With this type of transplant, patients receive lower doses of chemotherapy drugs and/or radiation. They receive immunosuppressive drugs to prevent rejection of the graft (donated cells) so that the donor's immune cells can attack cancer cells. This attack is called the graft-versus-tumor (GVT) effect
Studies are researching the use of this type of transplant in older adults who have relapsed and/or who have refractory disease. Reduced-intensity stem cell transplantation is usually used for patients who are older than 55 to 60 years.