Contrasting impacts of pretransplant cytoreduction and post‐transplant maintenance on outcomes of allogeneic haematopoietic stem cell transplantation in myelodysplastic syndromes: Real‐world multicentre evidence

作者：Yi Chen, Xiaotong Zhang, Na Shen, Jing Zhang, Rong Guo, Haizhou Xing, Lijie Han, Yi Liu, Wenliang Tian, Mengdi Wang, Xinsheng Xie, Zhongxing Jiang, Dingming Wan, Xuefang Zhou, Huili Xu, Ling Qin, W. Shi, Weijie Cao, Zhilei Bian · 发表于：British Journal of Haematology · 年份：2026 · DOI：10.1111/bjh.70477 · 被引用次数：2 · 研究领域：Acute Myeloid Leukemia Research、Hematopoietic Stem Cell Transplantation、Myeloproliferative Neoplasms: Diagnosis and Treatment

Summary Allogeneic haematopoietic stem cell transplantation (allo‐HSCT) remains the only curative therapy for patients with high‐risk myelodysplastic syndrome (MDS). However, the optimal timing and value of pretransplant cytoreduction and post‐transplant maintenance remain unclear, and transplant‐modifiable variables are not well defined in real‐world settings. We retrospectively analysed 215 consecutive MDS patients who underwent allo‐HSCT. Clinical, molecular and transplant‐related factors were evaluated for their impact on relapse, relapse‐free survival (RFS) and overall survival (OS). TP53 mutation, complex karyotype, and positive measurable residual disease (MRD) after cytoreductive treatment were associated with increased relapse risk. Among transplant‐related variables, younger donor age (<42 years) and higher CD34 + cell dose (≥3.1 × 10 6 /kg) significantly reduced relapse risk. Notably, pretransplant cytoreduction did not confer measurable benefit on outcomes. In contrast, post‐transplant maintenance therapy significantly reduced relapse incidence and prolonged RFS. Pretransplant cytoreduction offers limited clinical value, whereas post‐transplant maintenance and modifiable transplant variables (CD34 + cell dose and donor age) substantially improve outcomes after allo‐HSCT for MDS. These findings highlight actionable strategies that may refine transplant decision‐making and optimize outcomes in clinical practice.