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This review synthesizes MDS-specific evidence on transplant indication and timing, conditioning, donor choice, molecular predictors, and post-transplant surveillance. Prospective biologic-assignment studies support a survival benefit in fit older adults with higher-risk MDS. The Molecular International Prognostic Scoring System (IPSS-M), transplant-specific cytogenetic and mutational factors, comorbidity, and transfusion burden refine selection beyond the Revised International Prognostic Scoring System (IPSS-R). Alternative donors expand access, including haploidentical transplantation with post-transplant cyclophosphamide. Conditioning intensity should reflect both disease risk and patient fitness, with regimen-level scoring emerging for cord blood transplantation. Although non-relapse mortality has decreased over time, relapse remains the major unresolved cause of failure. MDS-specific measurable residual disease, graft-versus-host disease, cytomegalovirus assessment, and risk-adapted post-transplant interventions provide a practical framework for individualized care.<\/jats:p>","DOI":"10.1177\/09636897261499610","type":"journal-article","created":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T14:07:24Z","timestamp":1792332444000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Personalized allogeneic hematopoietic stem cell transplantation in myelodysplastic syndromes: Integrating molecular risk, donor selection, and post-transplant strategies"],"prefix":"10.1177","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-1061-3938","authenticated-orcid":false,"given":"Yu","family":"Wang","sequence":"first","affiliation":[{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-4633-3167","authenticated-orcid":false,"given":"Xumeng","family":"Zhao","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7274-6774","authenticated-orcid":false,"given":"Yi","family":"Xiao","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,10,18]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.3390\/curroncol31040148"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.semcancer.2026.01.006"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.14578"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2023.284946"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40164-025-00678-9"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17152469"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.03380"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02724"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/EVIDoa2200008"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.22.01784"},{"issue":"4","key":"e_1_3_5_12_2","first-page":"168","article-title":"Are We Undercounting MDS? 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