We would like to thank Prof. Nicolaus Kröger for his comments on our article, especially in relation to allogeneic hematopoietic stem cell transplantation in patients with MDS.
Adding to the data of the German Registry for Stem Cell Transplantation, we can show in the MDS Registry Düsseldorf that 8% of patients who underwent allogeneic stem cell transplantation after 2010 were aged 70 years and older. The median age in the allogeneic hematopoietic stem cell transplantation cohort increased from 37 years before 2000 to 52 years in 2000–2010 and 61 years from 2010.
In clinical practice, there is no age limit as an exclusion criterion; instead, comorbidities, biological age, and the wishes of the patients are essential components of the transplant eligibility evaluation. The likely higher vulnerability of this patient population to side effects of conditioning regimens is addressed through the use of reduced-intensity conditioning (RIC), as noted in the body text of the article.
We fully endorse the recommendation to also evaluate patients with low-risk MDS for allogeneic hematopoietic stem cell transplantation after a lack of response to treatment modalities in light of unfavorable parameters, such as very severe cytopenia, high IPSS-M risk category and high WT1 ratio (1).
Footnotes
Conflict of interest statement
KN received lecture fees from Jazz.
References
- 1.Nachtkamp K, Kobbe G, Gattermann N, Germing U. Myelodysplastic syndromes: new methods of diagnosis, prognostication, and treatment. Dtsch Arztebl Int. 2023;120:203–210. doi: 10.3238/arztebl.m2023.0005. [DOI] [PMC free article] [PubMed] [Google Scholar]