Research presented at the 64th American Society of Hematology Annual Meeting & Exposition found that use of the Molecular International Prognostic Scoring System (IPSS-M) Risk Stratification Model led to reclassification of almost half of patients with hypoplastic myelodysplastic syndromes (h-MDS)—and the different stratifications were associated with important differences in survival outcomes. The authors said their study appears to be the first external validation of the new tool in a large cohort of this patient population.
“Generalized use of this tool will likely result in more accurate prognostic assessment and optimize therapeutic decisions,” concluded the authors, led by Luis E. Aguirre, MD, of the Department of Malignant Hematology at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida. The team also found that the IPSS-M supports the World Health Organization’s decision to make h-MDS a distinct category.
The IPSS-M expands on the original IPSS-revised by including data on somatic oncogenic mutations. The current study sought to assess the validity of the tool for risk stratification of h-MDS in patients treated at a tertiary referral center. The team analyzed clinical and molecular data of 281 patients with MDS. They identified at least 349 driver point mutations involving as many as 98 genes, as well as at least one gene mutation in 66.9% of the sample (n=188) and two or more in 37% of the sample (n=104). The most common mutations were TP53 (n=51; 18%), TET2 (n=37; 13%), DNMT3A (n=35; 12%), RUNX1 (n=32; 11%), and U2AF1 (n=21; 7%).
With the IPSS-M model, the patients were classified as very low (3%; n=8), low (19.9%; n=56), moderate low (20.3%; n=57), moderate high (14.9%; n=42), high (20.6%; n=58), and very high (21.4%; n=60).
When the researchers compared the IPSS-M to the IPSS-R, 45.7% patients would have been classified differently (n=128). Of those, 68% of patients classified as very-low risk on the IPSS-R were staged up. The same was true of 42% classified as intermediate on the IPSS-R, as well as 28% of those classified as high on the IPSS-R. Only 19 patients (6.8%) moved down from higher-risk categories on the IPSS-M to lower and intermediate risk categories on the IPSS-R.
Aguirre LE, Al Ali N, Ball S, et al. Assessment of the Molecular International Prognostic Scoring System (IPSS-M) risk stratification model in hypoplastic myelodysplastic syndromes. Abstract #3073. Presented at the 64th American Society of Hematology Annual Meeting, December 10-13, 2022; New Orleans, Louisiana.