International Prognostic Scoring System (IPSS) for myelodysplasia

Prognosis of myelodysplastic syndromes (MDS)

1. Sum the scores for each factor (marrow blast %, cytogenetics and cytopenias)

ScoreBlasts (%)Karyo­type (1)Cyto­penias (2)
0< 5Good0 or 1
0.55 - 10Inter­mediate2 or 3
1.511 - 20
2.021 - 30
(1) Karyotypes: Good = normal, -Y, del(5q-) only, del(20q-) only. Poor = complex (≥3 abnormalities), or chromosome 7 abnormalities. Intermediate = all others
(2) Cytopenias: Neutrophils < 1.5 x 109/L, Platelets < 100 x 109/L, Hemoglobin < 10 g/dL

2. Use summed scores to determine risk category and prognosis

ScoreRisk categoryMedian OS (years)Median leukemia-free survival (years)
0.5 - 1.0Inter­mediate-13.52.7
1.5 - 2.0Inter­mediate-21.20.95
≥ 2.5High0.40.3

The IPSS was based upon a multivariate analysis of survival and freedom from progression to acute myeloid leukaemia of 816 patients with de novo myelodysplastic syndrome.1 Weighted scores for each of three disease features are used to generate four prognostic categories. In addition to the features used in the final score, age was associated with survival, but not with freedom from progression.

The revised IPSS (IPSS-R) was based on a much larger cohort and provides more precise estimates of prognosis than the original IPSS presented here.