NCCN Guidelines for Patients® | Myelodysplastic Syndromes
25 NCCN Guidelines for Patients ® : Myelodysplastic Syndromes, 2018 3 Prognostic scoring Risk groups: lower risk versus higher risk Guide 3. Risk groups: Lower-risk versus higher-risk MDS Lower-risk MDS Higher-risk MDS • IPSS Low and Intermediate-1 • IPSS-R Very Low, Low, Intermediate • WPSS Very Low, Low, Intermediate • IPSS Intermediate-2 and High • IPSS-R Intermediate, High, Very High • WPSS High, Very High ª This system gives points for five main prognostic factors. See Guide 2. The points for each of the factors are added together to make the IPSS-R score and assign the IPSS-R risk group. WPSS The WPSS is also a newer scoring system. But, it is not used as often as the IPSS or IPSS-R. A key way the WPSS differs from the other two systems is that it includes the MDS subtype as a prognostic factor. As for low blood cell counts, the WPSS gives a score based on the presence or absence of severe anemia. Like the IPSS-R, this system also has five risk groups. In this system, points are given for three main prognostic factors. See Guide 2. The points for each of the factors are added together to make the overall risk score. This is called the WPSS score and it is used to assign the WPSS risk group. Risk groups: lower risk versus higher risk When planning treatment, doctors often separate patients into two groups, dividing them into those with “lower-risk” and “higher-risk” MDS. Lower-risk MDS includes certain risk groups from each of the scoring systems. Likewise, higher-risk MDS includes risk groups from each of the scoring systems. Guide 3 shows how the risk groups are split into these two main categories. In general, lower-risk MDS is more likely to grow and progress slowly over time. It may not cause many or severe symptoms for several years. Thus, less intensive treatment is often used. Higher-risk MDS is more likely to progress faster or turn into AML more quickly without treatment. It may cause more symptoms and health problems in a short amount of time. Thus, for patients who fall into the “higher risk” category, more intensive treatment is often recommended. Doctors define risk-using information from large groups of patients. Thus, a risk group gives an average risk. Some people will do better than expected. Others will do worse. Several other important factors are not included in the scoring systems. These include your age, your general health, your ability to do daily activities, and any other health conditions that might complicate your treatment. A key point to remember is that these scoring systems and risk groups do not predict how MDS will respond to treatment. They only help predict how MDS will likely behave over time without treatment.