Revised International Prognostic Scoring System for MDS Is Better at Predicting Survival than Older Systems


Key Points

  • The recently published Revised International Prognostic Scoring System (IPSS-R) is superior in predicting overall and leukemia-free survival in patients with myelodysplastic syndrome (MDS) than the older IPSS and WHO Prognostic Scoring System.
  • The study found the ability to predict leukemic evolution is particularly important in lower-risk MDS patients, which represent the majority of patients.
  • Early recognition of patients at high risk of progression to aggressive disease may optimize treatment timing in MDS.

A retrospective analysis of 380 patients with myelodysplastic syndrome (MDS) registered in the Gruppo Romano Mielodisplasie Italian Regional database, which included data from 13 hematology centers in the Rome area, has found that the Revised International Prognostic Scoring System (IPSS-R) is significantly better than the IPSS and WHO Prognostic Scoring System (WPSS) at predicting overall and leukemia-free survival. The study results were published in the Journal of Clinical Oncology.

To determine the validity of the IPSS-R in accurately predicting prognosis and life expectancy of patients with MDS, researchers compared the prognostic value of the IPSS, WPSS, and IPSS-R using the Cox regression model and the likelihood ratio test. They found a significantly higher predictive power for leukemia-free survival and overall survival for the IPSS-R (P < .001). In addition, the researchers analyzed the predictive value of IPSS-R integrating into the multivariate analysis IPSS, WPSS, age, Eastern Cooperative Oncology Group (ECOG) performance status, lactate dehydrogenase (LDH), ferritin concentration, transfusion dependency, and type of treatment received by the patients.

The 380 patients included 182 women and 198 men, with a median age of 71. Most of the patients had good performance status—90% of the patients had an ECOG performance status of 0 to 1. The majority of patients were treated with vitamins, erythropoiesis-stimulating agents, and transfusion support. Active treatment, including lenalidomide (Revlimid), azacitidine (Vidaza), or cytotoxic drugs were administered to 26% of patients.

Patients were classified into five risk categories: very low, low, intermediate, high, and very high. According to the IPSS-R, most patients had a very low or low risk (38% and 33%, respectively), 18% of the patients had an intermediate risk, and 7% and 4% of patients had a high and very high risk, respectively. LDH concentration, as a parameter of disease activity, significantly correlated with patients’ IPSS-R subgroup (P = .007), according to the abstract.

Predicting MDS Progression Especially Useful in Low-risk Patients

“The precise definition of a prognostic score and of the probability of leukemic evolution is particularly important in the lower MDS risk groups, which represent the majority of patients with MDS, in whom new approaches, including allogeneic stem-cell transplantation in younger patients, may be addressed in a refined manner,” wrote the researchers.

The researchers concluded that their data show that the IPSS-R “is an excellent predictor of MDS prognosis in the era of disease-modifying treatments” and that IPSS-R “will be useful for risk-adapted patient management and will improve patient-physician communication, especially given the new therapeutic possibilities in MDS.”

The Revised International Prognostic Scoring System was developed by the International Working Group for Prognosis in MDS.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.