Criteria
Molecular International Prognostic Scoring System (IPSS-M) risk assessment[62]
A refined version of the IPSS and IPSS-R that combines somatic mutations (31 genes) with haematological and cytogenetic parameters to risk stratify patients with MDS. The IPSS-M classifies MDS patients into the following six risk groups based on a risk score derived from clinical (bone marrow blast percentage, platelet count, haemoglobin level), cytogenetic, and genetic prognostic factors:
Very low risk (risk score: ≤-1.5)
Low risk (risk score: >-1.5 to -0.5)
Moderate low risk (risk score: >-0.5 to 0)
Moderate high risk (risk score: >0 to 0.5)
High risk (risk score: >0.5 to 1.5)
Very high risk (risk score: >1.5).
A web-based IPSS-M calculator is available: MDS Foundation: IPSS-M risk calculator Opens in new window
Revised International Prognostic Scoring System (IPSS-R) risk assessment[63]
A refined version of the IPSS, using a larger patient database (Revised IPSS [IPSS-R], n = 7012, IPSS, n = 816) for analysis. Multiple statistically weighted clinical features were used to generate prognostic indicators.
Bone marrow blasts
≤2% = 0 points
>2% to 5% = 1 point
5% to 10% = 2 points
>10% = 3 points.
Karyotype (cytogenetic testing)
Very good risk: -Y, del(11q) = 0 points
Good risk: normal, del(5q), del(12p), del(20q), double including del(5q) = 1 point
Intermediate risk: del(7q), +8, +19, i(17q), any other single or double independent clones = 2 points
Poor risk: -7, inv(3)/t(3q)/del(3q), double including -7/del(7q), or complex 3 abnormalities = 3 points
Very poor risk: complex >3 abnormalities = 4 points.
Haemoglobin (g/dL)
≥10 = 0 points
8 to <10 = 1 point
<8 = 1.5 points.
Platelets (x 10⁹/L)
≥100 = 0 points
50 to <100 = 0.5 points
<50 = 1 point.
Absolute neutrophil count (× 10⁹/L)
≥0.8 = 0 points
<0.8 = 0.5 points.
Total summed score:
<1.5 points = very low risk
>1.5 to 3.0 points = low risk
>3.0 to 4.5 points = intermediate risk
>4.5 to 6.0 points = high risk
>6 points = very high risk.
A web-based IPSS-R calculator is available. [ Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome Opens in new window ]
International Prognostic Scoring System (IPSS) risk assessment[64]
Scores for three domains (bone marrow blasts, karyotype, and peripheral blood cytopenias) are summed to give an overall score and assign a risk category; age (≤60 years) is also important.
Bone marrow blasts
<5% = 0 points
5% to 10% = 0.5 points
NA = 1 point
11% to 20% = 1.5 points
21% to 30% = 2 points.
Karyotype (cytogenetic testing)
Good risk: normal, isolated-Y, isolated del(5q), or isolated del(20q) = 0 points
Intermediate risk: all karyotypes not defined as good or poor = 0.5 points
Poor risk: abnormal chromosome 7, or a complex karyotype (3 or more abnormalities) = 1 point.
Peripheral blood cytopenias
0 or 1 = 0 points
2 or 3 = 0.5 points.
Total summed score:
0 points = low risk
0.5 to 1.0 points = intermediate-1 (INT-1) risk
1.5 to 2.0 points = INT-2 risk
≥2.5 points = high risk.
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