Molecular Scoring System IPSS-M Demonstrates Superior Predictive Potential for Survival and AML Transformation Among Patients With MDS

Results from a Retrospective Study

The International Prognostic Scoring System-Molecular (IPSS-M), a molecular scoring system, demonstrated superior discriminative potential in predicting survival outcomes and acute myeloid leukemia (AML) transformation compared to IPSS-Revised (R) among patients with myelodysplastic syndrome (MDS), according to findings from a retrospective study published in the Leukemia & Lymphoma. 

In lieu of a proposal of the IPSS-M for the treatment of MDS, Jean M G Sabile, MD, Oregon Health & Science University, Portland, Oregon, and coauthors aimed to retrospectively evaluate its efficacy in predicting outcomes among adult patients with MDS. The primary and secondary end points included leukemia-free survival, overall survival, and the cumulative incidence of AML transformation 3 years after diagnosis. 

In this retrospective study, a total of 144 patients diagnosed with MDS were included. IPSS-M re-stratification was employed to identify patients according to their molecular risk profile. 

There were notable changes in risk stratification after the implementation of IPSS-M, as 33% of patients were up-staged while 11% were down-staged. At a median follow-up of 2.8 years, 37% of patients (n = 53) experienced mortality. There was a cumulative incidence of AML transformation of 20% at 3 years after diagnosis.

While IPSS-R was associated with leukemia-free survival and overall survival, IPSS-M was found to be a more accurate predictive tool. Log-rank tests of IPSS-M indicated significant associations and better discrimination than IPSS-R for leukemia-free survival as well as overall survival. 

Dr Sabile et al concluded, “This mutation-incorporating prognostic index has greater discriminative potential than IPSS-R to predict AML transformation and any-cause mortality.” 

Source: 

Sabile J MG, Kaempf A, Tomic K, et al. A retrospective validation of the IPSS-M molecular score in primary and therapy-related myelodysplastic syndromes (MDS). Leuk & Lymph. Published online: July 13, 2023. doi: 10.1080/10428194.2023.2232491