Original IPSS-R for MDS: the 2012 basic model

The Revised International Prognostic Scoring System (IPSS-R) combines five variables measured at diagnosis: a reviewed cytogenetic risk category, bone marrow blast percentage, hemoglobin, platelet count, and absolute neutrophil count (ANC). The original model was developed for primary, untreated myelodysplastic syndromes (MDS). AML is an MDS-evolution endpoint in the model, not the population being scored.

Open the original IPSS-R calculator

Published point table

| Component | Category | Points | |---|---|---:| | Cytogenetics | Very good / Good / Intermediate / Poor / Very poor | 0 / 1 / 2 / 3 / 4 | | Marrow blasts | 0-2% / >2-<5% / 5-10% / >10-30% | 0 / 1 / 2 / 3 | | Hemoglobin | >=10 / >=8-<10 / <8 g/dL | 0 / 1 / 1.5 | | Platelets | >=100 / >=50-<100 / <50 x10^9/L | 0 / 0.5 / 1 | | ANC | >=0.8 / <0.8 x10^9/L | 0 / 0.5 |

The exact total ranges from 0 to 10 in half-point increments.

Cytogenetic categories require expert review

• Very good: -Y; del(11q).
• Good: normal; del(5q); del(12p); del(20q); double including del(5q).
• Intermediate: del(7q); +8; +19; i(17q); any other single or double independent clones.
• Poor: -7; inv(3)/t(3q)/del(3q); double including -7/del(7q); complex karyotype with exactly three abnormalities.
• Very poor: complex karyotype with at least four abnormalities.

Isolated del(7q) is Intermediate, whereas monosomy 7 is Poor. A double abnormality including -7/del(7q) is Poor. Exactly three abnormalities is Poor; four or more is Very poor. The calculator does not parse raw karyotype text.

Original historical outcomes

| Exact total | Group | Median overall survival | Time for 25% to develop AML | |---:|---|---:|---:| | <=1.5 | Very low | 8.8 years | Not reached | | >1.5-3.0 | Low | 5.3 years | 10.8 years | | >3.0-4.5 | Intermediate | 3.0 years | 3.2 years | | >4.5-6.0 | High | 1.6 years | 1.4 years | | >6.0 | Very high | 0.8 years | 0.73 years |

These are historical observations from the original untreated primary-MDS cohort. They are not individualized contemporary predictions and do not prescribe treatment or transplant timing.

Population and limits

The development dataset required stable blood counts for at least two months and excluded secondary or therapy-related MDS and prior disease-altering MDS therapy. Patients were at least 16 years old, with marrow blasts up to 30%, peripheral blood blasts up to 19%, WBC up to 12 x10^9/L, and ANC up to 8 x10^9/L.

The official calculator operationally accepts marrow blasts 0-30%, hemoglobin 4-20 g/dL, platelets 0-2000 x10^9/L, and ANC 0-15 x10^9/L. ANC above 8 remains outside the original inclusion limit and should be flagged. Marrow blasts of 20-30% were included historically, but current disease classification should be confirmed before using this historical MDS model.

Age, peripheral blood blasts, and WBC are not inputs in the basic calculator, so their scope conditions must be checked separately.

Do not mix IPSS-R with related models

• Original IPSS: the earlier 1997 model.
• IPSS-RA: an age-adjusted survival extension, not the basic score implemented here.
• IPSS-M: a separate 2022 molecular model incorporating somatic mutations.
• Established AML: requires an AML-specific diagnostic and prognostic framework; this MDS calculator is not an AML prognosis tool.

Primary and official sources

1. Greenberg PL, et al. Blood. 2012;120(12):2454-2465. Full article. DOI: 10.1182/blood-2012-03-420489.
2. Schanz J, et al. J Clin Oncol. 2012;30(8):820-829. Full article. DOI: 10.1200/JCO.2011.35.6394.
3. MDS Foundation calculators.
4. Official advanced IPSS-R calculator.

Official supplements were reviewed; no correction to the basic five-variable point table was identified.