International Prognostic Scoring System-Molecular changes clinical management

Implementing the International Prognostic Scoring System-Molecular (IPSS-M) in clinical practice could impact clinical management for nearly half of patients with myelodysplastic syndromes (MDS), according to a study published online May 18 in Frontiers in Oncology.

Irene Zamanillo, from University Hospital 12 Octubre in Madrid, and colleagues analyzed clinical, cytogenetic, and molecular data from 166 MDS patients. IPSS-Revised and IPSS-M were calculated and survival was assessed.

The researchers found that 86.1 percent of patients had at least one genetic alteration, including most frequently SF3B1 (25.9 percent), DNMT3A (16.8 percent), and ASXL1 (14.4 percent). Nearly half of patients (48.2 percent) were restratified with IPSS-M, including 16.9 percent who were downgraded and 31.3 percent who were upgraded.

For overall survival, IPSS-M improved outcome prediction with a Harrell's c-index of 0.680 versus 0.626, and 0.801 versus 0.757 for leukemia-free survival. For nearly one-quarter of patients (22.2 percent), the reclassification of the IPSS-M could potentially affect clinical management, with 17.4 percent eligible for treatment intensification and 4.8 percent for treatment reduction.

"IPSS-M implementation in clinical practice could imply different treatment approaches in a significant number of patients," the authors write. "Our work validates IPSS-M in an external cohort and confirms its applicability in a real-life setting."