Study Evaluates IPSS-M, IPSS-R in MDS

A recent study “validates the utility” of the Molecular International Prognostic Scoring System (IPSS-M) and the Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes (MDS) but suggests a key caveat.

Brian Chernak, MD, of the Columbia University Irving Medical Center and colleagues presented the research during the 2023 American Society of Clinical Oncology Annual Meeting.

The IPSS-M was recently developed to “build on the traditional IPSS-R and is reported to be prognostic even with incomplete molecular data,” according to Dr. Chernak and colleagues. They aimed to validate the scoring system with an external set of data and evaluate a patient population that “typically does not contain complete molecular testing at diagnosis.”

The single-center study included patients with MDS who were identified in the institutional tissue bank and had documented peripheral blood counts, bone marrow biopsies, and cytogenetic data. After the study’s investigators eliminated repetitive patient samples, they included 405 patients in the study with samples collected between July 7, 2010, and March 29, 2022.

Of those patients, 392 were previously categorized with an IPSS-R score, 332 patients had at least one subsequent follow-up event, and 94 patients had bone marrow biopsies that were within 12 months of diagnosis. The median patient age was 74 years, and the median follow-up duration was 1.5 years.

“Nearly all patients had at least partial molecular diagnostic data,” Dr. Chernak and colleagues wrote. “Other than PRPF8 mutations (0%), all other mutations included in the IPSS-M scoring system were tested in a subset of the study population.”

The researchers reported SF3B1 mutations in 20.4% of patients, ASXL1 mutations in 17.6% of patients, and SRSF2 mutations in 15.9% of patients. They detected del(5q) in 12.2% of patients and found that 5.6% of patients had at least one TP53 mutation, with 2.7% of patients having a multihit TP53 status.

Nearly one-third (29%) of patients were upstaged from their IPSS-R score by the IPSS-M, while 12% were downstaged from their IPSS-R score by the IPSS-M.

At the time of study evaluation, 84 events had occurred and 61.3% of patients were alive. The median overall survival (OS) was 3.6 years.

When the researchers limited the analysis to patients with bone marrow biopsies within 12 months of their diagnosis, they found statistically significant differences in overall survival (OS) among IPSS-M categories (P<.000001) as well as IPSS-R categories (P<.00001). However, there was no statistical difference in survival among IPSS-M categories (P=.6) or IPSS-R categories (P=.2) if they calculated the scores at any time point in the patient’s disease course.

“This study validates the utility of both the IPSS-M and the IPSS-R scoring systems, and notably retains important risk stratification with incomplete diagnostic data,” Dr. Chernak and colleagues concluded. “Importantly, the scoring systems are not effectively prognostic as the disease progresses, and thus should only be utilized at or near the time of diagnosis.”

Reference

Chernak B, Ali A, Jan A, Mukherjee S, Jurcic JG, and Raza A. External validation of the Molecular International Prognostic Scoring System (IPSS-M) for myelodysplastic syndromes. Abstract 7056. Presented at the 2023 American Society of Clinical Oncology Annual Meeting; June 2-6, 2023; Chicago, Illinois.