Table 1.
The most widely used prognostic schemes for myelodysplastic syndromes (MDS): the International Prognostic Scoring System (IPSS) (reference 21), the revised IPSS (IPSS-R) (reference 25••), the World Health Organization (WHO) Classification-Based Prognostic Scoring System (WPSS) (reference 30), the MD Anderson Global Prognostic Scoring System (MDAPSS) (reference 45), and the MD Anderson Lower-Risk Prognostic Scoring System (LR-MDAPSS) (reference 32)
| IPSS, 1997
|
IPSS-R, 2012
|
WPSS, 2007
|
MDAPSS, 2008
|
LR-MDAPSS%, 2008
|
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|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Parameter | Score | Parameter | Score | Parameter | Score | Parameter | Score | Parameter | Score | |||||
| BM blasts % | BM blasts % | WHO Class | PS >2 | 2 | Cytogenetics*** | |||||||||
| <5 % | 0 | ≤2 % | 0 | RA, RARS, 5q- | 0 | Age (years) | Unfavorable | 1 | ||||||
| 5 – 10 % | 0.5 | >2 to<5 % | 1 | RCMD, RCMD-RS | 1 | 60–64 | 1 | Age (years) | ||||||
| 11 – 20 % | 1.5 | 5 – 10 % | 2 | RAEB-I | 2 | ≥ 65 | 2 | ≥ 60 | 2 | |||||
| 21 – 30 % | 2.0 | > 10 % | 3 | RAEB-II | 3 | Platelets (× 109/L) | Hb | |||||||
| Cytogenetics* | Cytogenetics** | Cytogenetics* | <30 | 3 | < 10 g/dL | 1 | ||||||||
| Good | 0 | Very Good | 0 | Good | 0 | 30 – 49 | 2 | Platelets | ||||||
| Intermediate | 0.5 | Good | 2 | Intermediate | 1 | 50 – 199 | 1 | < 50 ×109/L | 2 | |||||
| Poor | 1.0 | Intermediate | 4 | Poor | 2.0 | Hb <12 g/dL | 2 | 50 – 200 × 109/L | 1 | |||||
| Poor | 6 | RBC Transfusion†† | BM blasts % | BM blasts % | ||||||||||
| Very poor | 8 | Yes | 1 | 5 – 10 % | 1 | ≥ 4 % | 1 | |||||||
| Cytopenias† | Hb | ≥ 10 g/dL | 0 | No | 0 | 11 – 29 % | 2 | |||||||
| 0/1 | 0 | 8 – <10 g/dL | 1 | WBC >20×109/L | 2 | |||||||||
| 2/3 | 0.5 | < 8 g/dL | 1.5 | Cytogenetics | ||||||||||
| ANC (× 109/L) | ≤ 0.8 | 1 | Chromosome 7 Abn | 3 | ||||||||||
| Platelets (×109/L) | ≥ 100 | 0 | Complex ≥ 3 | 3 | ||||||||||
| 50 – 100 | 0.5 | RBC Transfusion | 1 | |||||||||||
| Risk Group | Score | OS (Y) | Risk Group | Score | OS (Y) | Risk Group | Score | OS (M) | Risk Group | Score | OS (M) | Risk Group | Score | OS (M) |
| Low | 0 | 5.7 | Very good | 0 – 2 | 8.8 | Very Low | 0 | 141 | Low | 0 – 4 | 54 | Cat-1 | 0 – 2 | 80 |
| INT-1 | 0.5 – 1 | 3.5 | Good | 3 – 5 | 5.3 | Low | 1 | 66 | INT-1 | 5 – 6 | 25 | Cat-2 | 3 – 4 | 27 |
| INT-2 | 1.5 – 2.0 | 1.1 | INT | 6 – 7 | 3.0 | INT | 2 | 48 | INT-2 | 7 – 8 | 14 | Cat-3≥514 | ||
| High | ≥ 2.5 | 0.4 | Poor | 8 – 9 | 1.6 | High | 3 – 4 | 26 | High | ≥ 9 | 6 | |||
| Very poor | 10 – 18 | 0.8 | Very High | 5 – 6 | 9 | |||||||||
: The LR-MDAPSS is a secondary classifier that applies only to MDS patients who belong to the IPSS low and INT-1 risk groups. BM: Bone marrow, PS: Performance status, RA: refractory anemia, RARS: refractory anemia with ring sideroblasts, RCMD: Refractory cytopenia with multilineage dysplasia, RAEB: Refractory anemia with excess blasts, 5q-: interstitial deletion of long arm of chromosome 5, Hb: hemoglobin, g: Gram, L; Liter, dL: deciliter, ANC: absolute neutrophil count, RBC: red blood cells, Abn: Abnormality, OS: Median overall survival, Y: years, M: months. Cat: Category.
Good: Normal, -Y, 5q-, 20q-; Poor: complex (≥ 3 abnormalities) or chromosome 7 abnormalities. Intermediate: Other karyotypic abnormalities;
Hb<10 g/dL; ANC<1800/μL; platelets< 100,000/μL.
Refer to Table 2 for cytogenetic groups used in the IPSS-R.
RBC transfusion dependence: ≥ 1 RBC transfusion every 8 weeks over a period of 4 months.
In this analysis, diploid and 5q were favorable cytogenetics, all others were considered as unfavorable cytogenetics