NCCN Guidelines for Patients® | Myelodysplastic Syndromes

23 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 3 Prognostic scoring Prognostic factors | Prognostic scoring Prognostic scoring is how doctors rate the severity of MDS. It is used to assess the likely outcome (prognosis) of MDS and plan treatment. The rating, called a risk score, is used to classify MDS into risk groups. Part 3 describes the key factors and scoring systems that are used for MDS. Prognostic factors Prognosis is a prediction of the pattern and outcome of a disease. As part of treatment planning, your doctors will assess the prognosis of your MDS. A key aspect of the prognosis of MDS is the chance (risk) that it will progress to AML. There are certain factors related to your blood counts, bone marrow assessment, and karyotype/molecular profile that affect the prognosis of MDS. These are called prognostic factors. Doctors use these factors to help decide if cancer treatment is needed right away and how intensive treatment needs to be. Such factors include: † † The MDS subtype † † The number and severity of low blood cell counts (cytopenias) † † The percent of blast cells in the bone marrow † † The type and number of chromosome changes Some factors are linked with better outcomes or a lower chance that MDS will turn into AML. Other factors are linked with poorer outcomes or a higher chance that MDS will turn into AML. Some factors help to predict the response to treatment. Based on these prognostic factors, doctors use a scoring system to rate and classify the severity of MDS. Prognostic scoring and risk groups Doctors use a points system to rate the severity of MDS in each patient based on certain prognostic factors. This is called prognostic scoring. Prognostic scoring systems help predict outlook (such as survival) and the risk of progression to AML. They assign a risk score and risk group for MDS based on the prognostic factors. First, each factor is given a score based on its severity. A lower score means a better outlook. The scores for all of the factors are then added together to make the overall risk score. The risk score describes how slow or fast MDS will likely grow and progress to AML if not treated. The risk score is used to assign the risk group. A risk group includes cases of MDS that have the same or similar risk scores. Cases of MDS in the same risk group will behave in a similar way. Doctors use the risk group to decide what type of treatment to use and when. There are three main prognostic scoring systems for MDS: † † IPSS ( I nternational P rognostic S coring S ystem) † † IPSS-R ( R evised I nternational P rognostic S coring S ystem) † † WPSS ( W HO classification-based P rognostic S coring S ystem) IPSS The IPSS was the first prognostic scoring system for MDS to be broadly used. It was created almost 20 years ago. Although it is still the most commonly used scoring system, many MDS specialists are moving away from the IPSS and towards the R-IPSS. As a result of these changes, the IPSS-R is better at predicting prognosis than the IPSS.