Proposal for a new risk model in myelodysplastic syndrome that accounts for events not considered in the original International Prognostic Scoring System

Cancer. 2008 Sep 15;113(6):1351-61. doi: 10.1002/cncr.23697.


Background: Recent studies have highlighted issues with the International Prognostic Scoring System (IPSS) model in relation to the exclusion of many subgroups that now represent a large proportion of patients with myelodysplastic syndrome (MDS) (eg, secondary MDS, chronic myelomonocytic leukemia [CMML] with leukocytosis, prior therapy) and its lack of applicability to most patients on investigational programs, because many would have received prior therapies and would have had MDS for a significant length of time.

Methods: The authors analyzed 1915 patients with MDS who were referred from 1993 to 2005 (including those with CMML, secondary MDS, and MDS with prior therapy). Only 507 patients (26%) had primary MDS without prior therapy (ie, classifiable by the IPSS). Patients were divided randomly into a study group (n = 958) and a test group (n = 957). RESULTS.: A multivariate analysis of prognostic factors in the study group identified the following adverse, independent factors as continuous and categoric values (P<.001): poor performance, older age, thrombocytopenia, anemia, increased bone marrow blasts, leukocytosis, chromosome 7 or complex (>or=3) abnormalities, and prior transfusions. Cutoffs for anemia, thrombocytopenia and blasts, and cytogenetic subsets were different according to the IPSS. The new MDS prognostic model divided patients into 4 prognostic groups with significantly different outcomes. The model was validated in the test group. Applying the prognostic score of the new model within the 4 IPSS risk groups, overall, and in patients who had primary MDS without prior therapy was found to be highly prognostic in each subset. Applying the IPSS within each of the 4 risk groups of the new MDS model was not found to be prognostic.

Conclusions: The new model accounts for duration of MDS and prior therapy. It is applicable to any patient with MDS at any time during the course of MDS.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blast Crisis
  • Chromosome Aberrations*
  • Chromosomes, Human, Pair 7 / genetics
  • Female
  • Humans
  • Male
  • Middle Aged
  • Models, Theoretical*
  • Myelodysplastic Syndromes / classification
  • Myelodysplastic Syndromes / diagnosis*
  • Myelodysplastic Syndromes / genetics
  • Myelodysplastic Syndromes / therapy
  • Prognosis
  • Risk Assessment
  • Survival Rate