The landscape of transplantation in myelodysplastic syndrome (MDS) has evolved rapidly in the last decade, driven mostly by advances in patient selection through better risk stratification, increasing age of allogeneic recipients, introduction of reduced-intensity conditioning regimens, increased availability of unrelated donors, new donor sources, and improvements in transplant technology and supportive care. Despite these advances, several issues, mostly centering on approaches to improve post-transplant survival while minimizing transplant-related mortality, continue to present significant challenges. Advances in understanding the molecular pathogenesis of MDS have made it feasible to construct clinically useful risk models that integrate prognostic genes with conventional risk parameters for better selection of patients likely to benefit from hematopoietic cell transplantation. Simultaneous research efforts in several areas, including comorbidity assessment, novel preparative regimens, optimal pretransplant cytoreductive strategy, and post-transplantation therapies, are expected to improve long-term disease-free survival and quality of life.

Gait speed and grip strength are widely used measures of physical function in older adults and are predictive of disability, hospitalization, and mortality. However, there is a limited understanding of the long-term trajectories of these measures and which older adults are at the highest risk of functional decline. We used data from the National Health and Aging Trends Study (NHATS) to identify subgroups of community-dwelling older adults with distinct 10-year trajectories in gait speed and grip strength and to examine the baseline factors associated with these patterns. The sample included 4961 adults aged 65 years and older who completed gait speed and grip strength assessments in 2011 and at least one subsequent wave between 2013 and 2021. Using latent class growth analysis, we identified three trajectories for each measure: worsening, stable, and improving. More than one-third of participants were in the worsening group for at least one measure. In multinomial logistic regression models, lower income, Medicaid coverage, cognitive impairment, and multiple chronic conditions were associated with membership in worsening trajectory groups. These findings highlight the heterogeneity of physical aging and the importance of the early identification of older adults who may benefit from targeted interventions to maintain function and independence over time.