Revised international prognostic scoring system (IPSS-R) in myelodysplastic syndrome

Prognostic variable	Score
	0	0.5	1.0	1.5	2.0	3.0	4.0
Cytogenetics*	Very good		Good		Intermediate	Poor	Very poor
Bone marrow blast (%)	≤2		>2 to <5		5 to 10	>10
Hemoglobin (g/dL)	≥10		8 to <10	<8
Platelets (cells/microL)	≥100	50 to 100	<50
Absolute neutrophil count (cells/microL)	≥0.8	<0.8
This scoring system was applied to an initial group of 7012 patients with primary MDS by the French-American-British classification who had at least 2 months of stable blood counts, ≤30% bone marrow blasts and ≤19% peripheral blood blasts, and who were observed until progression to AML transformation or death (did not receive disease-modifying agents for MDS). Patients could be stratified into 5 groups with the following estimated overall survival and progression to AML.
Risk group		IPSS-R score		Median overall survival (years)		Median time to 25% AML evolution (years)
Very low		≤1.5		8.8		>14.5
Low		>1.5 to 3.0		5.3		10.8
Intermediate		>3 to 4.5		3.0		3.2
High		>4.5 to 6		1.6		1.4
Very high		>6		0.8		0.7
The prognostic value of the IPSS-R was validated in an external cohort of 200 patients with MDS.

AML: acute myeloid leukemia; MDS: myelodysplastic syndromes.

* Cytogenetic definitions:

Very good: –Y, del(11q)
Good: Normal, del(5q), del(12p), del(20q), double including del(5q)
Intermediate: del(7q), +8, +19, i(17q), any other single, double not including del(5q) or –7/del(7q), or independent clones
Poor: –7, inv(3)/t(3q)/del(3q), double including –7/del(7q), complex: 3 abnormalities
Very poor: Complex: >3 abnormalities

This research was originally published in Blood. Greenberg PL, Tuechler H, Schanz J, et al. Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes. Blood 2012. Copyright © 2012 the American Society of Hematology.

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Revised international prognostic scoring system (IPSS-R) in myelodysplastic syndrome