HCT With PTCy in Higher-risk MDS

Inclusion Criteria

• •MDS defined by WHO classification, CMML, or AML evolving from MDS A. International Prognostic Scoring System (IPSS) \> 1.0 or bone marrow blast ≥ 5% at any time points before HCT or B. AML progressed from MDS or C. CMML with bone marrow blast ≥ 5% at any time points before HCT
• •Patients receiving first HCT
• •Patients with appropriate hematopoietic cell donors A. HLA-matched sibling donor B. Unrelated donor C. HLA-mismatched familial donor
• •15 years old or older , under 75 years
• •Adequate performance status (Karnofsky score of 70 or more)
• •Adequate hepatic function (AST or ALT \< 3 x upper normal limits and bilirubin \< 1.5 x upper normal limit).
• •Adequate renal function (creatinine \< 2.0 mg/dL or creatinine clearance ≥ 50 mL/min)
• •Adequate cardiac function (left ventricular ejection fraction ≥ 50% on heart scan or echocardiogram)
• •Adequate pulmonary function: DLCO, FEV1, and FVC ≥ 45% predicted by pulmonary function tests
• •Signed and dated informed consent must be obtained from both recipient and donor.