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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.
The revised International Prognostic Scoring System (IPSS-R) is based on 5 factors:
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:
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.
The World Health Organization (WHO) scoring system is based on 3 factors:
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:
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.
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:
Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.
Della Porta MG, Tuechler H, Malcovati L, et al. Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia. 2015;29:1502-1513.
Estey EH, Schrier SL. Prognosis of the myelodysplastic syndromes in adults. UpToDate. 2017. Accessed at https://www.uptodate.com/contents/prognosis-of-the-myelodysplastic-syndromes-in-adults on October 11, 2017.
Greenberg PL, Tuechler H, Schanz J, et al. Revised international prognostic scoring system for myelodysplastic syndromes. Blood. 2012;120(12):2454-2465.
Malcovati L, Germing U, Kuendgen A, et al. Time-dependent prognostic scoring system for predicting survival and leukemic evolution in myelodysplastic syndromes. J Clin Oncol. 2007;25:3503-3510.
Steensma DP, Stone RM. Chapter 99: Myelodysplastic syndromes. In: Abeloff MD, Armitage JO, Niederhuber JE. Kastan MB, McKenna WG, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Revised: January 22, 2018
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