Prognostic assessment, rather than staging, is a critical element in treatment planning and should be clearly documented in the patient’s medical record.
Prognosis and progression to AML can vary among patients depending on the risk of their disease (Bewersdorf et al. 2020; Sekeres & Cutler 2014; Volpe & Komoroji 2021). Due to the diversity of MDS subtypes, they are categorised as higher risk and lower risk. This is determined by prognostic systems based most commonly on blast percentage, cytogenetic risk groups and cytopenias but may also include age, performance status, transfusion needs and other clinical (and increasingly molecular) factors.

Commonly used prognostic scoring systems for MDS include:

• the International Prognostic Scoring System (IPSS)
• the Revised IPSS (IPSS-R) (Fenaux et al. 2021; Harris 2020; Sekeres & Cutler 2014).

Prognostic systems are evolving; please refer to the most current classification systems. In this document we define:

• higher risk MDS as an IPSS score of intermediate (2 or higher), or an IPSS-R score of high/very high risk
• lower risk MDS as low/intermediate (1 in IPSS and very low, low or intermediate in IPSS-R) (Volpe & Komoroji 2021).

Note that ‘intermediate’ on IPSS-R is sometimes considered to be higher risk and sometimes considered lower risk, depending on the patient’s individual circumstances.

As prognostic scoring systems evolve, it is likely that results of molecular testing will also be incorporated into such models.