International Prognostic Scoring System (IPSS)
The IPSS is a system used to assess risk and predict clinical outcomes in MDS. It is based on 3 prognostic factors:
- BM blast cell percentage, which falls into 1 of 4 categories:
- <5%
- 5% to 10%
- 11% to 20%
- 21% to 30%
- Cytogenetic pattern (karyotype), which is categorized into 1 of 3 definitions:
- Good (normal karyotype or isolated –Y, del 5q, or del 20q)
- Intermediate (other chromosomal abnormalities)
- Poor (complex karyotype consisting of 3 or more abnormalities, or chromosome 7 abnormalities)
- Number and degree of cytopenias
Based on these and other prognostic factors, the IPSS stratifies patients into risk categories by score1:
- Low risk (0)
- Intermediate-1 risk (0.5 to 1.0)
- Intermediate-2 risk (1.5 to 2.0)
- High risk (≥2.5)
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| Factor | Value | IPSS Score |
|---|
Blasts in
bone marrow2 |
less than 5% |
0 |
| 5% to 10% | 0.5 |
| 11-20% | 1.5 |
| 21-30% | 2.0 |
| Cell DNA changes (cytogenics)2 |
Good |
0 |
| Intermediate | 0.5 |
| Poor | 1.0 |
| Low blood counts or cytopenias2 |
0 or 1 cytopenias |
0 |
| 2 or 3 cytopenias | 0.5 |
Origins of the IPSS
Between 1982 and 1997, at least 7 risk classification systems were proposed to evaluate the potential clinical outcomes for patients with MDS (including the French-American-British classification, the Sanz score, and the Lille score). Each of these systems used differing clinical variables to classify risk, including bone marrow (BM) morphological classification, BM myeloblast percentage, BM biopsy features, specific cytopenias, age, lactate dehydrogenase level, and BM cytogenetic pattern.
An International MDS Risk Analysis Workshop was convened to evaluate these systems and develop a consensus prognostic risk-based analysis system with greater discriminating power.
Workshop participants performed a global analysis on the combined cytogenic, morphological, and clinical data from 816 patients with primary MDS in 7 previously reported studies that had generated prognostic systems. Critical variables were reevaluated using this data, and these analyses formed the basis of the IPSS.3,4
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