Among patients with myelodysplastic syndromes (MDS), compared with the Revised International Prognostic Scoring System (IPSS-R), the Molecular IPSS (IPSS-M) appears to both improve prognostic classification and better select patients for hematopoietic stem cell transplantation (HSCT), according to research published in the Journal of Clinical Oncology.
Currently, the IPSS-R is the standard measure used to prognostically stratify patients using bone marrow blasts, blood cytopenias, and cytogenetic abnormalities. Previous research has suggested, however, that the IPSS-R may not correctly stratify individual patients, especially in the era of advanced genomic sequencing evaluating somatic gene mutations.
The IPSS-M was developed by the International Working Group for Prognosis in MDS in order that both clinical and molecular characteristics were included in a prognostic measurement; for this study, researchers evaluated the prognostic utility of the IPSS-M among patients with MDS.
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Overall, data from 2876 patients were included. Among these, 61% were male sex, the median age was 68 years, the median hemoglobin levels were 10 g/dL, and the median platelet levels were 110. Using IPSS-R criteria, 10% of patients had very low–risk disease, while 28%, 21%, 21%, and 20% of patients had low-, intermediate-, high-, and very high-risk disease, respectively; using IPSS-M, criteria, these figures were 9.6%, 27.7%, 10.6%, 11.1%, 19.3%, and 21.7%, respectively.
Analysis showed that the IPSS-M had improved prognostic discrimination compared with the IPSS-R across clinical endpoints (for overall survival, concordance was 0.81 vs 0.74, respectively; for leukemia-free survival, 0.89 vs 0.76) — regardless of the presence of genetic abnormalities.
Using IPSS-M criteria, 46% of patients had a risk group change from the IPSS-R (23.6% upstaged, 22.4% downstaged).
IPSS-M criteria also improved relapse prediction and post-HSCT survival among the patient subgroup who underwent HSCT (overall survival concordance in IPSS-M vs IPSS-R, 0.76 vs 0.6, respectively; for probability of relapse, 0.89 vs 0.7).
The analysis did show, however, that the IPSS-M was not effective at predicting probability of response to, or survival after receiving, hypomethylating agents.
“Despite the improved prognostication provided by IPSS-M, we observed that demographic features have a high predictive prognostic power, and clinical parameters (bone marrow blasts and anemia) still retain a strong predictive effect on survival, suggesting that these variables reflect important features of the disease state that are not captured by genomic landscape,” the authors noted in their report.
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of authors’ disclosures.
Reference
Sauta E, Robin M, Bersanelli M, et al. Real-world validation of Molecular International Prognostic Scoring System for myelodysplastic syndromes. J Clin Oncol. Published online March 17, 2023. doi:10.1200/JCO.22.01784
