Validation of the Revised International Prognostic Scoring System for Patients with Myelodysplastic Syndromes

Abstract

The objective of this study is to externally validate the recently published Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome (MDS) and compare it with the International Prognostic Scoring System (IPSS). We conducted a retrospective study of 173 adult MDS patients who had not received disease-altering treatment. Using the Cox hazard method, we found the IPSS-R to be a significant predictor of survival (p < 0.001, hazard ratio, HR = 1.82, 95% confidence interval, CI 1.57-2.12) and time to acute myeloid leukemia (AML; p < 0.001, HR = 2.05, 95% CI 1.55-2.70). The IPSS-R has greater prognostic power for survival and time to AML compared with the IPSS, given higher Somers' D values (0.41 vs. 0.39 and 0.55 vs. 0.53, respectively). Using the log-rank test, we found a significant difference when comparing IPSS-R groups (p < 0.02), with the exception of the high-risk versus very high-risk group comparison. The IPSS-R reclassified low-risk and intermediate-1 IPSS groups into four groups (log-rank, p < 0.001) and intermediate-2 and high-risk IPSS groups into three groups (log-rank, p < 0.04, excluding high-risk vs. very high-risk comparison). We conclude that the IPSS-R has significant prognostic utility for MDS patients.

Monosomal karyotype is an independent predictor of survival in patients with higher‐risk myelodysplastic syndrome

“…The IPSS‐R and WPSS scoring systems are more accurate than the IPSS in estimating survival . In addition, the IPSS‐R has been validated in several independent datasets , whereas there have been few validations of the WPSS in large datasets. We confirmed the predictive value of the WPSS in a cohort of 598 patients ( P < 0.001 for trend), and our results further showed that the IPSS‐R, which was based on data from untreated patients, was a good predictor of survival in MDS patients who had received treatment.…”

IPSS‐R in 555 Taiwanese patients with primary MDS: Integration of monosomal karyotype can better risk‐stratify the patients

“…Compared with IPSS, the IPSS-R split patients with fewer than 5% BM blast into those with 0%-2% and greater than 2% to fewer than 5%, incorporated more sophisticated cytogenetic classification to separate patients into five, rather than three risk subtypes, and scored the depth of cytopenias to improve prognosis assessment for primary MDS patients [4]. It has been shown that IPSS-R predicts survival and leukemic evolution in MDS patients significantly better than IPSS in Western countries [5][6][7][8]. Since the demographics and disease natures in MDS patients are different between Asian and Western countries [9][10][11][12], it is unclear whether this new risk model is similarly useful for risk stratification of MDS in Asia.…”

Comparison of the prognostic utility of the revised International Prognostic Scoring System and the French Prognostic Scoring System in azacitidine‐treated patients with myelodysplastic syndromes

“…Although the revised IPSS (IPSS‐R) showed improved prognostic precision over the IPSS, both the IPSS and the IPSS‐R were developed using cohorts of untreated patients (Greenberg et al , , ). The IPSS‐R has subsequently been shown to have prognostic value among treated MDS patients in retrospective analyses (Lamarque et al , ; Mishra et al , ; Savic et al , ; Voso et al , ; Neukirchen et al , ).…”