IPSS-M: the molecular international prognostic scoring system for myelodysplastic syndromes
By adding mutations in 31 genes to blood counts and chromosomes, the IPSS-M sorts myelodysplastic syndromes into six risk groups and reclassifies about half of patients compared with the older score.
Overview
Development and validation of a prognostic model in 2,957 patients with MDS, combining clinical variables, cytogenetics and mutations in 31 genes into a continuous score with six risk categories; validated in an independent cohort of 754 patients.
TP53 multi-hit, FLT3 and MLL partial tandem duplications carried the most adverse weight; SF3B1 was favourable. Compared with IPSS-R, 46 percent of patients were reclassified, most often upwards.
- Six risk categories with median survival from over 10 years to about one year.
- 46 percent of patients reclassified compared with IPSS-R, 74 percent of those to a higher risk group.
Sequencing at diagnosis now changes the risk group, and therefore the transplant discussion, for a large fraction of patients. Trials and guidelines are adopting the IPSS-M in place of the IPSS-R.
- Requires a broad myeloid sequencing panel that is not universally available.
- Derived mostly from untreated patients at diagnosis.