IPSS-R for Myelodysplastic Syndrome
Revised International Prognostic Scoring System for MDS. Predicts overall survival and AML transformation risk.
Score interpretation
IPSS-R Very Low (≤ 1.5): Median OS ~8.8 years. Very low AML transformation risk.
→ Watchful waiting if asymptomatic. Treat cytopenias symptomatically: ESA for anaemia (EPO < 500), G-CSF for severe neutropenia. Transfusion support if needed. 3–6 monthly haematology review.
IPSS-R Low (1.5–3): Median OS ~5.3 years. Low AML transformation risk.
→ Active monitoring. ESA ± G-CSF for symptomatic cytopenias. Lenalidomide for del(5q). Transfusion chelation if > 20 units packed red cells (deferasirox). Consider clinical trial enrolment.
IPSS-R Intermediate (3–4.5): Median OS ~3 years. Significant AML transformation risk.
→ Haematology specialist care. Consider azacitidine (hypomethylating agent) if unfit for transplant. Allogeneic SCT discussion if fit and donor available. Clinical trial if available. Transfusion support.
IPSS-R High (4.5–6): Median OS ~1.6 years. High risk of AML transformation.
→ Azacitidine 75 mg/m² SC days 1–7, every 28 days. Allogeneic SCT if eligible (age < 70, fit, matched donor). Clinical trial. Intensive AML-type induction if very fit and blast > 10%. Palliative care involvement early.
IPSS-R Very High (> 6): Median OS ~0.8 years. Very high AML transformation risk.
→ Urgent allogeneic SCT workup if eligible. Azacitidine bridging therapy. Best supportive care if unfit for transplant. Early palliative care integration. Advance care planning.
Interpretation bands for the IPSS-R (MDS). Apply clinical judgement and local guidance.
References
- Greenberg PL et al. Revised International Prognostic Scoring System for Myelodysplastic Syndromes. Blood. 2012.
Related
Curated clinical cross-links plus same-class fallbacks.
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Alendronic Acid (Alendronate) · Bisphosphonate (bone resorption inhibitor)
- Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)
- Azacitidine · Hypomethylating Agent — MDS / AML
- Teriparatide · Parathyroid Hormone Analogue (Anabolic Bone Agent)
- Denosumab · Anti-RANKL Monoclonal Antibody
- Major Haemorrhage / Massive Transfusion · BCSH; RCOA; RCEM; RCS — BCSH Guidelines
- Anaemia Investigation · BSH / NICE
- Splenomegaly Workup · BSH; BMJ Best Practice
- Deep Vein Thrombosis Diagnosis and Treatment · NICE CG144 / NICE NG158
- Sickle Cell Crisis · BSH 2021 / BCSH
- Neutropenic Sepsis · NICE CG151 2012 / ESMO
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.