In-hospital mortality and complications are increased in hematopoietic stem cell transplant recipients with myelodysplastic syndromes.

Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative therapy for patients with myelodysplastic syndromes (MDS). Despite evidence of comparable outcomes in selected older adults, disparities in HSCT utilization persist. This study analyzes trends, outcomes, and barriers such as age and insurance status associated with HSCT in MDS. We performed a retrospective analysis of the National Inpatient Sample (NIS) from 2016 to 2020 using ICD-10 codes to identify adult patients undergoing allogeneic HSCT. Patients were stratified according to MDS diagnosis. National estimates were calculated using discharge weights. Baseline characteristics and outcomes were compared using Pearson Chi-square and t-tests. Propensity score matching was used to adjust for potential confounders. Among 30,460 patients who underwent allogeneic HSCT, 4,980 (16.16%) had MDS. MDS patients were older (median age 62 vs. 49 years, p<0.001) and had a higher burden of comorbidities, including chronic lung disease, diabetes, and hypertension (p<0.001). They were more likely to be insured through Medicare (38.73% vs. 17.10%) and less likely to have private insurance (50.80% vs. 56.96%, p<0.001). From 2016 to 2020, the proportion of HSCT performed in patients with MDS increased from 13.20% to 17.32% before a slight decline in 2020. MDS patients experienced in-hospital mortality (aOR 1.33, 95% CI 1.14-1.55), mechanical ventilation (aOR 1.30), neutropenic fever (aOR 1.20), and acute GVHD (aOR 1.26), but lower Clostridium difficile infection (aOR 0.75). MDS patients undergoing allogeneic HSCT are older, carry greater comorbidity burdens, and have worse in-hospital outcomes. Insurance disparities and age may continue to represent barriers despite increasing utilization. Further research is needed to optimize selection and peri-transplant care.