A retrospective validation of the IPSS-M molecular score in primary and therapy-related myelodysplastic syndromes (MDS)

Abstract

A molecular scoring system (IPSS-M) was recently proposed for myelodysplastic syndrome (MDS). We conducted a retrospective study of adults with MDS referred 2019–2021. The primary outcomes were leukemia-free survival (LFS) and overall survival (OS). One hundred and forty-four patients diagnosed between 2011 and 2021 were analyzed. After IPSS-M re-stratification, 33% of patients were up-staged and 11% down-staged. Median follow-up was 2.8 years and 53 patients died (37%). Cumulative incidence of acute myeloid leukemia (AML) transformation was 20% at 3 years post-diagnosis. International Prognostic Scoring System (IPSS), revised version (IPSS-R) was significantly associated with LFS (log-rank p = 9.2e–05; ‘very high’ vs. ‘low’ risk HR = 3.85, p = 5.8e–04) and OS (log-rank p = 7.2e–06; ‘very high’ vs. ‘low’ HR = 5.09, p = 1.7e–04). IPSS-M was also a significant predictor of LFS (log-rank p = 1.1e–06; ‘very high’ vs. ‘low’ HR = 4.97, p = 2.2e–05) and OS (log-rank p = 4.8e–07; ‘very high’ vs. ‘low’ HR = 6.42, p = 2.5e–05) while providing better discrimination than IPSS-R for both outcomes. This mutation-incorporating prognostic index has greater discriminative potential than IPSS-R to predict AML transformation and any-cause mortality.