Impact of IPSS-M implementation in real-life clinical practice

Area of Science:

• Hematology
• Oncology
• Genetics

Background:

• Myelodysplastic syndromes (MDS) are a group of clonal hematopoietic stem cell disorders.
• Accurate risk stratification is crucial for guiding treatment decisions in MDS.
• The International Prognostic Scoring System for Myelodysplastic Syndromes with Molecular Aberrations (IPSS-M) is a novel scoring system incorporating molecular data.

Purpose of the Study:

• To evaluate the relevance of the IPSS-M score in guiding treatment choices for MDS patients in a real-life clinical setting.
• To compare the predictive accuracy of IPSS-M with the existing IPSS-R score.
• To assess the impact of IPSS-M re-stratification on potential clinical management changes.

Main Methods:

• Retrospective collection of clinical, cytogenetic, and molecular data from 166 MDS patients.
• Calculation of both IPSS-R and IPSS-M scores for all patients.
• Comparison of Overall Survival (OS) and Leukemia-Free Survival (LFS) between scoring systems.
• Analysis of how IPSS-M re-stratification could alter clinical management strategies.

Main Results:

• 86.1% of patients harbored at least one genetic alteration, with SF3B1, DNMT3A, and ASXL1 being the most frequent mutations.
• IPSS-M re-stratified 48.2% of patients (16.9% downgraded, 31.3% upgraded) compared to IPSS-R.
• IPSS-M demonstrated improved outcome prediction for OS (c-index 0.680 vs 0.626) and LFS (c-index 0.801 vs 0.757).
• Reclassification by IPSS-M could potentially impact clinical management in 22.2% of patients, suggesting treatment intensification for 17.4% and reduction for 4.8%.

Conclusions:

• The IPSS-M score shows significant applicability and validation in a real-world cohort of MDS patients.
• Implementation of IPSS-M in clinical practice may lead to altered treatment approaches for a substantial number of patients.
• IPSS-M enhances prognostic accuracy, supporting its use for personalized treatment strategies in MDS.