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However, the optimal timing and value of pretransplant cytoreduction and post\u2010transplant maintenance remain unclear, and transplant\u2010modifiable variables are not well defined in real\u2010world settings. We retrospectively analysed 215 consecutive MDS patients who underwent allo\u2010HSCT. Clinical, molecular and transplant\u2010related factors were evaluated for their impact on relapse, relapse\u2010free survival (RFS) and overall survival (OS).\n                    <jats:italic>TP53<\/jats:italic>\n                    mutation, complex karyotype, and positive measurable residual disease (MRD) after cytoreductive treatment were associated with increased relapse risk. Among transplant\u2010related variables, younger donor age (&lt;42\u2009years) and higher CD34\n                    <jats:sup>+<\/jats:sup>\n                    cell dose (\u22653.1\u2009\u00d7\u200910\n                    <jats:sup>6<\/jats:sup>\n                    \/kg) significantly reduced relapse risk. Notably, pretransplant cytoreduction did not confer measurable benefit on outcomes. In contrast, post\u2010transplant maintenance therapy significantly reduced relapse incidence and prolonged RFS. Pretransplant cytoreduction offers limited clinical value, whereas post\u2010transplant maintenance and modifiable transplant variables (CD34\n                    <jats:sup>+<\/jats:sup>\n                    cell dose and donor age) substantially improve outcomes after allo\u2010HSCT for MDS. These findings highlight actionable strategies that may refine transplant decision\u2010making and optimize outcomes in clinical practice.\n                  <\/jats:p>","DOI":"10.1111\/bjh.70477","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T12:47:08Z","timestamp":1775825228000},"page":"2156-2167","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Contrasting impacts of pretransplant cytoreduction and post\u2010transplant maintenance on outcomes of allogeneic haematopoietic stem cell transplantation in myelodysplastic syndromes: Real\u2010world multicentre evidence"],"prefix":"10.1111","volume":"208","author":[{"given":"Yilin","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Hematology The First Affiliated Hospital of Zhengzhou University  Zhengzhou 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