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Myelodysplastic Syndromes: IPSS-R Risk Stratification

The IPSS-R is a system used to assess risk and predict clinical outcomes in MDS. A revised version of the IPSS-R classification now includes 5 (instead of 3) cytogenetic prognostic factors:1

  • BM blast cell percentage, which falls into 1 of 4 categories:
    • ≤2%
    • >2%-<5%
    • 5->10%
    • >10%
  • Cytogenetic pattern (karyotype), which is categorized into 1 of 5 definitions:
    • Very good: -Y, del(11q)
    • Good: normal, del(5q), del(12p), del(20q), double including del(5q)
    • Intermediate: del(7q), +8, +19, i(17q), any other single or double independent clones
    • Poor: -7, inv(3)/t(3q)/del(3q), double including -7/del(7q); complex: 3 abnormalities
    • Very poor: Complex: >3 abnormalities
  • Hemoglobin, with 3 cutoff points:
    • ≥10 g/dL
    • 8-<10 g/dL
    • <8 g/dL
  • Platelets, with 3 cutoff points:
    • ≥100 x109/L
    • 50-<100 x109/L
    • <50 x109/L
  • ANC, with 2 cutoff points:
    • ≥0.8 x109/L
    • <0.8 x109/L

Based on these and other prognostic factors, the IPSS-R stratifies patients into risk categories by score:

  • Very low (≤1.5)
  • Low: (1.5-3)
  • Intermediate (3-4.5)
  • High: (4.5-6)
  • Very high (>6)

Table. The International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes (MDS)1

Factor Value IPSS-R score
Blasts in bone marrow ≤2% 0
>2%-<5% 1
5->10% 2
>10% 3
Cell DNA changes
(cytogenetics)
Very good 0
Good 1
Intermediate 2
Poor 3
Very poor 4
Hemoglobin ≥10 g/dL 0
8-< g/dL 1
<8 g/dL 1.5
Platelets ≥100x109/L 0
50-<100x109/L 0.5
<50x109/L 1
ANC ≥0.8x109/L 0
<0.8x109/L 0.5

The IPSS-R scoring system is used only at the time of MDS diagnosis as it does not take into account the impact of transfusions on the prognosis of MDS patients.2

Learn about a dynamic risk stratification system >

Reference

  1. Greenberg P, et al. Blood. 1997;89:2079-88.
  2. Garcia-Manero G. Hematology Am Soc Hematol Educ Program. 2010:330-7.

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