Age Is Just a Number: Early Transplant Referral in MDS/MPN

In an interview with Targeted Oncology, David Sallman, MD, of Moffitt Cancer Center, emphasizes that chronological age should no longer serve as a barrier to allogeneic stem cell transplant in patients with MDS/MPN. He notes that the age threshold is continually being pushed, citing his own experience transplanting an 80-year-old patient who is now thriving at 87. According to Dr. Sallman, the decision hinges less on age and more on clinical risk, molecular profile, and functional status.

He highlights a critical nuance: patients who are “molecularly upstaged”—those who appear clinically lower-risk but harbor high-risk mutations such as TP53—may achieve superior long-term survival by proceeding directly to transplant rather than pursuing a watch-and-wait approach or sequential therapies. He cautions that delaying referral often proves detrimental, as outcomes become marginal once patients develop hypomethylating agent (HMA)-refractory disease.

Dr. Sallman advocates for a low threshold to refer all medically fit patients for transplant evaluation, even if the ultimate decision is to defer intervention. Early referral allows transplant centers to assess candidacy, initiate donor searches, and formulate a proactive strategy before patients lose the opportunity due to disease progression or treatment failure. His approach underscores a shift toward integrating molecular risk stratification into transplant decision-making, ensuring that patients are evaluated sooner rather than later.