Clinical outcomes of patients with lower risk myelodysplastic syndrome from EUMDS registry eligible for transplantation: Implications for transplantation strategies.

Savic, A.; Taylor, A.; Fenaux, P.; Symeonidis, A.; Cargo, C.; Mittelman, M.; Petzer, V.; Sanz, G.; Cermak, J.; Langemeijer, S.; Hellstrom-Lindberg, E.; Comont, T.; D'Aveni, M.; Culligan, D.; Kotsianidis, I.; Panagiotidis, P.; van Marrewijk, C.; Smith, A.; Crouch, S.; de Witte, T.; Malcovati, L.

Clinical outcomes of patients with lower risk myelodysplastic syndrome from EUMDS registry eligible for transplantation: Implications for transplantation strategies.

All Authors

Savic, A.

Taylor, A.

Fenaux, P.

Symeonidis, A.

Cargo, C.

Mittelman, M.

Petzer, V.

Sanz, G.

Cermak, J.

Langemeijer, S.

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LTHT Author

Cargo, Catherine

LTHT Department

Oncology
Haematology
Haematological Malignancy Diagnostic Service

Publication Date

2026

Item Type

Journal Article

Subject

HAEMATOPOIETIC STEM CELL TRANSPLANTATION , COMORBIDITY , MYELODYSPLASTIC SYNDROMES , SURVIVAL RATE

Abstract

Selecting eligible allogeneic haematopoietic stem cell transplantation (allo-HSCT) candidates with low-risk and intermediate-risk myelodysplastic syndrome (MDS) remains controversial. The International Working Group (IWG) for MDS prognosis identified a Revised International Prognostic Scoring System (IPSS-R) score >3.5 for benefits from early transplantation; the MDS-RIGHT group uses a broader set of poor risk features. We analysed 1145 lower risk MDS (lower risk and intermediate-risk IPSS-R) patients aged <75 years, using real-world European Myelodysplastic Syndromes registry data and identifying those meeting IWG or MDS-RIGHT criteria for allo-HSCT at baseline and 6-month follow-up. Fit patients were characterised by Karnofsky score >=70 and Haematopoietic Cell Transplantation-specific Comorbidity Index <3. We evaluated clinical outcomes of transplant candidates, including survival, disease progression risk, new comorbidity risk and performance status decline. The IWG criterion, and not MDS-RIGHT criteria, identified patients with lower risk and intermediate-risk MDS with poorer baseline survival. Fit lower risk patients showed 2-year cumulative risks of incident comorbidity and performance status deterioration of 20% and 5% respectively. In summary, IWG and MDS-RIGHT features identify patients with lower or intermediate-risk MDS as candidates for early transplantation. Lower risk patients fit for transplantation have a cumulative incidence of adverse outcomes possibly jeopardising transplantation eligibility and should be carefully selected when planning delayed transplantation strategies.