ABSTRACT Aim of present study was to investigate the outcome of 94 adult patients with myelodysplasia (MDS) who received an allogeneic stem cell transplantation between January 1995 and September 2010 in two Italian hematological centers. At the time of transplant, 53 patients (56%) had relapsed/refractory disease. The cumulative incidence of grades II-IV acute graft-versus-host disease (GVHD) and chronic GVHD were 33% (21%-45%, 95% CI) and 78% (66%-90%, 95% CI) respectively. The cumulative incidence of transplant-related mortality (TRM) at 100 days was 13% (5%-21%, 95% CI). The 2-year progression free survival (PFS) and overall survival (OS) were 41% (31%-51%, 95% CI) and 49% (38%-59%, 95% CI) respectively. On multivariate analysis, advanced disease stage at transplantation was the major independent variable associated with an inferior 2-year PFS (HR 3.58, 1.93-6.64, 95% CI, p<0.001) and OS (HR 3.6, 1.90-6.83 95% CI). The use of an alternative donor was the independent variable associated with TRM (HR 3.50, 1.38-8.88, 95% CI, p 0.04). In conclusion, our data suggest that disease status at the time of transplant is the major predictor for improved PFS and OS, and treatments required to reach this goal may have value in leading to improved outcome.