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Hematopoietic cell transplantation in MDS: undervalued and underutilized

Bone Marrow Transplantation volume 51, pages 1069–1070 (2016)Cite this article

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Hematopoietic cell transplantation (HCT) is broadly underutilized,1, 2, 3 particularly in myelodysplastic syndromes (MDS), for which it is the only curative option. Surveys show that HCT is considered in <4% of patients with MDS in the United States.4 Older patient age, comorbidities and lack of appropriate donors are often cited as factors contributing to the limited application of HCT in MDS. However, favorable results achieved with non-myeloablative or reduced-intensity regimens and alternative donors in both younger and older patients with MDS5, 6 negate this logic.

Since MDS occurs mostly in older patients (median age at diagnosis of at least 65 years of age7) clinicians may question the extent to which a curative procedure will extend life in elderly patients; however, in many countries an individual 65 years of age currently has a life expectancy in excess of 20 additional years.8 Further, while quality of life (QOL) is a commonly stated concern, the study by El-Jawahri et al.9 in this issue of Bone Marrow Transplantation demonstrates that baseline patient-reported QOL among older patients with advanced MDS does not influence the decision to undergo HCT. In the context of the traditionally passive role that approximately half of the patients favor in MDS10 these data reveal that the patient’s QOL is not foremost in the decision-making process of many clinicians.

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Authors and Affiliations

  1. Levine Cancer Institute–Carolinas HealthCare System, Charlotte, NC, USA

    M R Grunwald, B R Avalos & E A Copelan

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  1. M R Grunwald
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  2. B R Avalos
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  3. E A Copelan
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Correspondence to M R Grunwald.

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Grunwald, M., Avalos, B. & Copelan, E. Hematopoietic cell transplantation in MDS: undervalued and underutilized. Bone Marrow Transplant 51, 1069–1070 (2016). https://doi.org/10.1038/bmt.2016.169

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