Dr Giralt on Determining Transplant Eligibility in MDS

Sergio A. Giralt, MD, deputy division head, Division of Hematologic Malignancies, Melvin Berlin Family Chair in Multiple Myeloma, Memorial Sloan Kettering Cancer Center, discusses how to determine transplant eligibility for patients with myelodysplastic syndromes (MDS), as well as the evolving role of transplant in this disease setting.

Transplant candidacy should ideally be determined by specialists within dedicated transplant centers, Giralt begins, adding that these centers are equipped with multidisciplinary teams that collaborate to make informed decisions, especially for older patients. A key component of this decision-making process is the comprehensive geriatric assessment (CGA), which Giralt notes is the standard of care. Giralt emphasizes that geriatricians play a crucial role in providing deep insights into the individual risks associated with transplantation. In general, factors such as disease risk, disease-specific characteristics, and patient-specific risk factors should be considered when determining a patient's eligibility for transplant, he states. This thorough evaluation ensures that each patient receives personalized care tailored to their unique health profile, Giralt explains.

Historically, transplant was limited to patients who had HLA-identical donors within their families or those who could find suitable matches through registries, Giralt continues. However, significant advancements have expanded donor availability, he says. The introduction of post-transplant cyclophosphamide has allowed for successful transplants even with mismatched and unrelated donors. Accordingly, the eligibility criteria for transplant have been expanded, allowing a much larger population to access this procedure, Giralt states.

Despite these advancements, access to transplantation remains a significant challenge, he notes. With the removal of age and HLA barriers, the primary issue now lies in ensuring equitable access for all eligible patients, Giralt says. There is still considerable physician and patient bias that limits transplant opportunities, particularly for older patients, he reports. Common misconceptions, such as the belief that patients are "too old" for transplantation, persist despite evidence to the contrary. Today, transplants are routinely performed in patients up to 80 years old, and a significant number of transplants are now being conducted in patients over 65 years of age, reflecting a shift towards more inclusive practices, Giralt concludes.

Clinicians referring a patient to MSK can do so by visiting msk.org/refer, emailing referapatient@mskcc.org, or by calling 833-315-2722.