Revised International Prognostic Scoring System (IPSS-R)

The IPSS-R, which is the most commonly used scoring system, is a refinement of the original International Prognostic Scoring System (IPSS) based on a much larger clinical database (N=7012).1

The IPSS-R considers 5 variables1:

  • Percentage of bone marrow (BM) blasts
  • Karyotype
  • Hemoglobin (Hb) levels
  • Platelets
  • Absolute neutrophil count (ANC)

Based on these variables, an overall score is calculated. Patients with scores ≤4.5 fall into lower-risk categories (very low, low, and intermediate risk). Intermediate risk in IPSS-R also includes patients that were previously IPSS intermediate-2 score and considered higher risk.1

Prognostic score values1

Score Value
Prognostic variable 0 0.5 1 1.5 2 3 4
BM blasts, % ≤2 >2 to <5 5 to 10 >10
Karyotype (see below) Very good Good Intermediate Poor Very poor
Hb, g/dL ≥10 8 to <10 <8
Platelets, x 109 cells/L ≥100 50 to <100 <50
ANC, x 109 cells/L ≥0.8 <0.8

—, not applicable; ANC, absolute neutrophil count; BM, bone marrow; Hb, hemoglobin.

Karyotype/Cytogenetic Abnormalities Prognostic Subgroup
-Y, del(11q) Very good
Normal del(5q), del(12p), del(20q), double including del(5q) Good
del(7q), +8, +9, i(17q), any other single or double independent clones Intermediate
-7, inv(3)/t(3q)/del(3q), double including -7/del(7q), complex: 3 abnormalities Poor
Complex: >3 abnormalities Very poor

The karyotype of the majority of patients is “Good” according to the prognostic subgroups, representing 72% of the population. The other cases are1:

  • 4% Very good
  • 13% Intermediate
  • 4% Poor
  • 7% Very poor
IPSS-R Prognostic Risk Categories/Scores
Very low Low Intermediate High Very high
≤1.5 >1.5-3 >3-4.5 >4.5-6 >6

Adapted from Greenberg et al. Blood. 2012;120(12):2454-2465.

Learn more about the distribution of prognostic scores at time of diagnosis.

Reference: 1. Greenberg PL, Tuechler H, Schanz J, et al. Revised International Prognostic Scoring System for myelodysplastic syndromes. Blood. 2012;120(12):2454-2465.