The Molecular International Prognostic Scoring System (IPSS-M) provided better risk discrimination compared with earlier renditions of the IPSS among patients with myelodysplastic syndromes (MDS) as identified by the 2022 International Consensus Classification (ICC) criteria, according to retrospective study.

The validation study, which was published in the Blood Cancer Journal, included data from 649 patients with MDS by the 2022 ICC criteria. Risk stratification was compared between the IPSS-M, the revised IPSS (IPSS-R), and the original IPSS.

Application of the IPSS-M resulted in the reclassification from the intermediate risk from of the IPSS-R to the moderate low or moderate high-risk groups of the IPSS-M among 42.5% of patients, with 29.3% upstaged and 13.2% downstaged.

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Among patients classified as intermediate risk by the IPSS-R, 23.1% were upstaged to the high-risk and 4.6% to the very high-risk group by the IPSS-M criteria and 20.6% were downstaged. There were 24% of patients whose reclassification spanned more than 1 risk group.

As a result of reclassification, there were 16.9% of patients for whom a different treatment strategy would have been reasonable, including 15.3% who had indications for a hypomethylating agent or a hematopoietic stem cell transplant. The C-index was 0.738, 0.710, and 0.681 for the IPSS-M, IPSS-R, and IPSS, respectively, for LFS and 0.730, 0.712, and 0.679, respectively, for OS.

The C-statistics were higher for the IPSS-M risk groups for leukemia-free survival (LFS) and overall survival (OS), which indicated that “the IPSS-M model could distinguish different risk categories more accurately than the IPSS-R and IPSS,” the authors wrote in their report.

“This study confirmed that the IPSS-M can better risk-stratified MDS patients for optimized therapeutic decision-making,” the authors concluded.

Lee W-H, Tsai M-T, Tsai C-H, et al. Validation of the molecular international prognostic scoring system in patients with myelodysplastic syndromes defined by international consensus classification. Blood Cancer J. 2023;13:120. doi: 10.1038/s41408-023-00894-8