Intensive treatment strategies in patients with high-risk myelodysplastic syndrome and secondary acute myeloid leukemia

Stem cell transplantation may lead to prolonged disease-free survival in yo ung patients with high-risk myelodysplastic syndrome (MDS) and secondary ac ute myeloid leukemia. About one-third of patients transplanted with an HLA- identical family donor will experience long-term disease-free survival. Out come appears to be better for younger patients, patients with less advanced stages of MDS and treatment early in the course of the disease, The result s of transplantation using partially matched family donors and phenotypical ly matched voluntary unrelated donors are still unsatisfactory mainly due t o significantly higher transplantation related mortality rate. For patients lacking a suitable sibling donor autologous stem cell transplantation may constitute an alternative. The presence of sufficient residual polyclonal s tem cells and achieving a complete remission after chemotherapy forms a pre requisite for a successful transplantation. Further development of accurate prognostic classification systems will allow a risk-adapted strategy for a n individual patient. (C) 2000 Harcourt Publishers Ltd.