Using IPSS-M to Identify Hidden High-Risk Lower-Risk MDS

Following a Frontline Forum program, Amer Zeidan, MBBS, MD, and Raji Shameem, MD, discussed the role of the Molecular International Prognostic Scoring System (IPSS-M) in identifying patients with clinically lower-risk myelodysplastic syndromes (MDS) who harbor hidden high-risk biology.

Both physicians described how incorporating molecular mutations formalizes a practice that predates the score, which helps flag patients for earlier transplant evaluation. Zeidan noted that patients classified as moderate-high, high-, or very high-risk by the IPSS-M may be considered for transplant up front, while Shameem emphasized the tool’s value for treatment selection in non-transplant practice.

Zeidan is a professor of medicine at Yale School of Medicine and chief of the Division of Hematologic Malignancies, director of Hematology Early Therapeutics Research, and assistant director of the Clinical Trial Office for Hematology at Yale Comprehensive Cancer Center. Shameem is a hematologist and medical oncologist at the Orlando Health Cancer Institute.

Transcript:

CancerNetwork: How is the IPSS-M changing how you catch "hidden" high-risk biology in clinically lower-risk disease? Does an adverse molecular profile prompt you to completely bypass standard treatment algorithms?

Zeidan: Before we had the IPSS-M, there were patients with what historically have been called lower-risk disease based on the IPSS or IPSS-R who we felt had worse outcomes because they had adverse molecular mutations. We would consider those patients for transplant relatively earlier in their disease course. We would not wait until they had gone through all the traditional treatments because we know their survival is somewhat limited, especially for younger patients or others who are candidates for allogeneic transplant.

What the IPSS-M did was formalize this process so that you are incorporating the mutations into the assessment. Patients who are moderate-high, high-, or very high-[risk] by the IPSS-M are being considered for transplant from the outset. There are patients who do not need intermediary therapy before transplant, such as those with low blasts and good counts but adverse risk by the IPSS-M. Again, the treatment is individualized in that setting.

Shameem: I agree completely. I’ve started incorporating it in my practice and I find it good for stratifying patients. I don’t perform transplant, but it helps me identify….[those] who need a transplant evaluation. I think about 30% of patients can be stratified to higher risk, and some patients can be stratified to lower risk, and it helps me identify the appropriate treatment for that specific patient. I agree 100%.

Reference

Bernard E, Tuechler H, Greenberg PL, et al. Molecular international prognostic scoring system for myelodysplastic syndromes. NEJM Evid. 2022;1(7):EVIDoa2200008. doi:10.1056/EVIDoa2200008