Myelodysplastic Syndrome Prognostic Scores

For most types of cancer, the stage of the cancer – a measure of how far it has spread – is one of the most important factors in selecting treatment options and in determining a person’s outlook (prognosis).

But myelodysplastic syndromes (MDS) are diseases of the bone marrow. The outlook for these cancers isn't based on the size of a tumor or whether the cancer has spread. Because of this, doctors use other factors to predict outlook and decide when to treat. Some of these factors have been combined to develop scoring systems.

Revised International Prognostic Scoring System (IPSS-R)

The revised International Prognostic Scoring System (IPSS-R) is based on 5 factors:

• The percentage of blasts (very early forms of blood cells) in the bone marrow
• The type and number of chromosome abnormalities in the cells
• The level of red blood cells (measured as hemoglobin) in the patient's blood
• The level of platelets in the patient's blood
• The level of neutrophils (a type of white blood cell) in the patient's blood

Each factor is given a score, with the lowest scores having the best outlook. Then the scores for the factors are added up to put people with MDS into 5 risk groups:

• Very low risk
• Low risk
• Intermediate risk
• High risk
• Very high risk

These risk groups can be used to help predict a person’s outlook. This can be helpful when trying to determine the best treatment options.

This system has some important limitations. For example, it was developed before many of the current treatments for MDS were available, so it only took into account people who were not treated for their MDS. It also did not include people who have MDS as a result of getting chemotherapy (secondary MDS). But this system can still be helpful and is still widely used.

WHO Prognostic Scoring System (WPSS)

The World Health Organization (WHO) scoring system is based on 3 factors:

• The type of MDS based on the WHO classification (For example, certain types of MDS-SLD and MDS-del(5q) tend to have the best outlook, whereas MDS-EB tends to have the worst.)
• Chromosome abnormalities (grouped as good, intermediate, or poor)
• Whether or not the patient needs regular blood transfusions

Each factor is given a score, with the lowest scores having the best outlook. Then the scores are added up to put people with MDS into 5 risk groups:

• Very low risk
• Low risk
• Intermediate risk
• High risk
• Very high risk

These risk groups can be used to help predict a person’s outlook, as well as how likely the MDS is to transform into acute myeloid leukemia (AML). This can be helpful when trying to determine the best treatment options. But as with the IPSS-R, this system has some important limitations. For example, it does not include people who have MDS as a result of getting chemotherapy (known as secondary MDS).

Both the IPSS-R and the WPSS can be complex, and different doctors might use different systems. If you have MDS, talk to your doctor about which system they use, which risk group you are in, and what it might mean for your treatment and outlook.

Other prognostic factors

Along with the factors used in these scoring systems, doctors have found other factors that can also help predict a person’s outlook. These include:

• A person’s age
• A person’s performance status (how well they’re able to do normal daily activities)
• The severity of low blood cell counts
• The results of certain blood tests, such as the serum ferritin level
• Certain gene or chromosome changes that are not accounted for in the scoring systems