IPSS-R

IPSS-R in Myelodysplastic Syndromes (MDS)

IPSS-R = Revised International Prognostic Scoring System

It’s the most widely used prognostic model for myelodysplastic syndromes (MDS), refining the original IPSS by adding more detail and better discrimination of risk.

What It Measures

IPSS-R uses five disease features at diagnosis:

1. Cytogenetics (karyotype)
   • Stratified into very good, good, intermediate, poor, very poor
   • Example: del(5q) = good, complex karyotype (≥3 abnormalities) = very poor
2. Bone marrow blast %
   • <2%
   • 2–<5%
   • 5–10%
   • 10%
3. Hemoglobin (g/dL)
4. Platelet count (×10⁹/L)
5. Absolute neutrophil count (ANC ×10⁹/L)

Each category assigns points → summed for a total score.

Risk Categories

Total score stratifies patients into five risk groups:

• Very Low
• Low
• Intermediate
• High
• Very High

Each corresponds to median survival and risk of progression to AML.

Clinical Use

• Prognosis: Predicts overall survival and risk of AML transformation.
• Treatment guidance:
  • Lower risk (Very Low, Low, some Intermediate):
    • Supportive care (transfusions, growth factors)
    • Lenalidomide (esp. del(5q))
    • Erythropoiesis-stimulating agents (ESAs)
    • Luspatercept for anemia with ring sideroblasts
  • Higher risk (High, Very High, some Intermediate):
    • Hypomethylating agents (azacitidine, decitabine)
    • Allogeneic stem cell transplant (curative option)
    • Clinical trials

Pharmacists use the IPSS-R category to:

• Determine intensity of therapy vs supportive care.
• Anticipate transfusion burden and infection risk.
• Guide discussion about ESA, lenalidomide, HMA use, or transplant referral.

Summary (pharmacist takeaway):

IPSS-R = refined prognostic tool in MDS using cytogenetics, blasts, Hb, platelets, and ANC. It stratifies patients into 5 risk groups, guiding prognosis and therapy (supportive vs disease-modifying).