Risk Stratification
Risk stratification of myelodysplastic syndromes (MDS) is important to determine prognosis and help understand disease trajectoryVolpe VO et al. Clin Lymphoma Myeloma Leuk. 2023;23:168-177.
The Revised International Prognostic Scoring System (IPSS-R) is the most commonly used risk stratification system in MDS.Volpe VO et al. Clin Lymphoma Myeloma Leuk. 2023;23:168-177. Greenberg PL et al. Blood. 2012;120:2454-2465.
- The IPSS-R stratifies patients into 5 risk groups (very low, low, intermediate, high, and very high), based on the sum of the individual scores for each parameterGreenberg PL et al. Blood. 2012;120:2454-2465.
- A cutoff point of ≤ 3.5 has generally been used to classify patients as lower-risk MDS (LR-MDS; median survival, 5.9 years) and > 3.5 for higher-risk MDS (HR-MDS; median survival, 1.5 years)Cazzola M. N Engl J Med. 2020;383:1358-1374.
Revised International Prognostic Scoring System (IPSS-R)Greenberg PL et al. Blood. 2012;120:2454-2465.
77%
of patients with MDS are lower-risk (very low-, low-, or intermediate-risk per IPSS-R).Greenberg PL et al. Blood. 2012;120:2454-2465.
An advanced calculator for IPSS-R MDS risk assessment is available online.
The Molecular International Prognostic Scoring System (IPSS-M) was recently developed, and integrates information from 31 gene mutations in addition to the IPSS-R componentsBernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
- The result of the IPSS-M is a continuous, patient-specific risk score that may be classified into 1 of 6 groups: very low, low, moderate low, moderate high, high, and very highBernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
- Compared with the IPSS-R, the IPSS-M improved prognostic discrimination and re-stratified 46% of patients to a different risk category (74% of whom were upstaged and 26% of whom were downstaged)Bernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
Molecular International Prognostic Scoring System (IPSS-M)Bernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
58%
of patients with MDS are lower-risk (very low-, low-, or intermediate-risk per IPSS-M).Bernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
A web-based IPSS-M calculator provides individual scores and estimates for leukemia-free survival, overall survival, and AML transformation risk.Bernard E et al. NEJM Evid. 2022;1:EVIDoa2200008.
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