目的：探讨异基因造血干细胞移植（allo-HSCT）治疗骨髓增生异常综合征演变的急性髓系白血病（MDS-AML）的疗效。方法：回顾性分析2018年1月至2022年8月在血液病研究所接受allo-HSCT治疗的54例MDS-AML患者，观察移植后的临床效果以及影响预后的相关危险因素。被探索了。结果：54例患者中，男性26例，女性28例，53例实现造血重建。中位随访597（15~1 934）天后，1年总生存率（OS）、无病生存率（DFS）、复发率（CIR）和非复发死亡率（NRM）分别为：分别为75.8%±5.8%、72.1%±6.1%、12.7%±4.9%和17.1%±5.2%。 3 年估计 OS、DFS、CIR 和 NRM 率分别为 57.8%±7.5%、58.1%±7.2%、23.2%±6.6% 和 23.7%±6.6%。急性移植物抗宿主病（aGVHD）累计发生率为57.5%±6.9%，慢性移植物抗宿主病（cGVHD）累计发生率为48.4%±7.7%。移植前造血细胞移植合并症指数（HCT-CI）≥2、重建当天微小残留病（MRD）阳性、Ⅲ/Ⅳ级aGVHD、细菌或真菌感染以及移植后无cGVHD为不良预后因素总生存期（P<0.05）。 COX回归模型多因素分析显示，移植前HCT-CI评分、缓解当日骨髓MRD、Ⅲ或Ⅳ级aGVHD、移植后cGVHD是OS的独立不良因素（P=0.001，HR=6.981， 95%CI 2.186-22.300；P=0.010，HR=6.719，95%CI 1.572-28.711；P=0.026，HR=3.386，95%CI 1.158-9.901；P=0.006，HR=0.151，95%CI 0.039 0.581）。结论：对于复发风险高的MDS-AML患者，必须尽早考虑同种异体移植。移植后应尽可能加强移植后并发症的管理和维持治疗。

Objective: The outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for myelodysplastic syndromes-evolved acute myeloid leukemia (MDS-AML) were explored. Methods: A retrospective review was conducted for 54 patients with MDS-AML treated with allo-HSCT in the Institute of Hematology and Blood Disease Hospital from January 2018 to August 2022. The clinical effects after transplantation were observed, and the related risk factors influencing prognosis were explored. Results: Of the total 54 patients, 26 males, 28 females, and 53 patients achieved hematopoietic reconstruction. After a median follow-up of 597 (15-1 934) days, the 1 year overall survival (OS) rate, disease-free survival (DFS) rate, relapse rate (CIR) and non-relapse mortality (NRM) rate were 75.8%±5.8%, 72.1%±6.1%, 12.7%±4.9%, and 17.1%±5.2%, respectively. The 3 year estimated OS, DFS, CIR, and NRM rates were 57.8%±7.5%, 58.1%±7.2%, 23.2%±6.6%, and 23.7%±6.6%, respectively. The cumulative incidence of acute graft-versus-host disease (aGVHD) was 57.5%±6.9%, and the cumulative incidence of chronic graft-versus-host disease (cGVHD) was 48.4%±7.7%. Hematopoietic cell transplantation comorbidity index (HCT-CI) before transplantation was ≥2, minimal residual disease (MRD) was positive on the day of reconstitution, grade Ⅲ/Ⅳ aGVHD, bacterial or fungal infection and no cGVHD after transplantation were adverse prognostic factors for OS (P<0.05). COX regression model for multivariate analysis showed that HCT-CI score before transplantation, bone marrow MRD on the day of response, grade Ⅲ or Ⅳ aGVHD, and cGVHD after transplantation were the independent adverse factors for OS (P=0.001, HR=6.981, 95%CI 2.186-22.300; P=0.010, HR=6.719, 95%CI 1.572-28.711; P=0.026, HR=3.386, 95%CI 1.158-9.901; P=0.006, HR=0.151, 95%CI 0.039-0.581) . Conclusion: For patients with MDS-AML and high risk of relapse, allogeneic transplantation must be considered as soon as possible. The enhanced management of post-transplantation complications and maintenance treatment should be provided whenever possible after transplantation.