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

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 (percent) ≤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 two months of stable blood counts, ≤30 percent bone marrow blasts and ≤19 percent 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 five groups with the following estimated overall survival and progression to AML.
Risk group IPSS-R score Median overall survival (years) Median time to 25 percent 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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