Impact of discordant revised versus molecular international prognostic scoring system risk in myelodysplastic syndrome

TO THE EDITOR:

Myelodysplastic syndromes (MDS) are hematopoietic stem cell (HSC) neoplasms that arise through a stepwise evolutionary process due to the expansion of clonal HSCs [1, 2]. The Revised International Prognostic Scoring System (IPSS-R), based on clinical and pathologic characteristics, has long been the standard risk stratification system used in clinical trials and practice [3]. Recent efforts have integrated genomic data within the Molecular International Prognostic Scoring System (IPSS-M) [4]. Compared to the IPSS-R, the IPSS-M results in a change in risk category in a significant number of patients, with major clinical implications. Indeed, the classification of a patient as either higher risk (HR) or lower risk (LR) is fundamental in the management of MDS, with widely differing treatment approaches. In this study, we evaluated a large cohort of patients with MDS and compared the characteristics and clinical behavior of patients who experienced a change in overall risk (HR versus LR) when re-stratified from IPSS-R to IPSS-M.