Dr Komrokji on Risk-Stratification Strategies in Myelodysplastic Syndromes

Rami Komrokji, MD, vice chair of the Malignant Hematology Department and senior member of the Malignant Hematology and Experimental Therapeutics Program at Moffitt Cancer Center, as well as a professor in medicine & oncologic sciences at the College of Medicine of the University of South Florida, discussed strategies and barriers for utilizing current risk-stratification tools in myelodysplastic syndromes (MDS).

Following the establishment of the original International Prognostic Scoring System (IPSS) criteria in 1997, revised criteria (IPSS-R) were released in 2012, then followed by the molecular IPSS (IPPS-M) in 2022. Along with featuring elements from the IPSS and IPSS-R criteria such as cytopenias, bone marrow blast percentage, and cytogenetics, IPPS-M incorporated molecular data into the risk-stratification model, Komrokji noted. For practices with access to next-generation sequencing (NGS), the inclusion of molecular features refined prognostic assessment and allowed clinicians to generate more precise survival estimates for patients with MDS, he continued.

Notably, Komrokji explained that following the original publication of IPSS-M and its data, this model has been validated by multiple studies, including studies conducted by Komrokji and colleagues at Moffitt Cancer Center. This growing body of evidence has supported the use of IPSS-M in clinical practice, particularly in settings where comprehensive molecular testing is available, he said.

However, practical limitations remain in some regions where access to NGS panels may be limited. In those situations, Komrokji emphasized that IPSS-R continues to serve as a reasonable risk-stratification tool. He also explained that an online IPSS-M calculator can serve as a practical resource, allowing clinicians to enter available variables and generate risk estimates, even in instances where some molecular data are missing. He said the tool could also provide a range of possible outcomes, reflecting best- and worst-case scenarios when full molecular data are not available.

Finally, Komrokji noted that IPSS-M could help guide treatment decisions, such as the timing of hematopoietic stem cell transplant. For example, he said that for a patient with disease harboring higher-risk features that could affect survival in the coming 2 years could justify the decision to head to transplant. However, risk upstaging alone does not necessarily mandate more aggressive therapy, particularly for older patients or those whose primary clinical issue remained symptomatic anemia, he said. In these cases, a stepwise treatment approach could still be appropriate despite higher-risk classification, Komrokji concluded.