ASH 2023 | Updates in MDS diagnosis and prognosis with the IPSS-M: personalized medicine in 2023
Rena Xian, MD, MS, Johns Hopkins University School of Medicine, Baltimore, MD, discusses the personalization of therapy in myelodysplastic syndromes (MDS), commenting on advances that have been made in the diagnosis and prognosis of patients. Dr Xian shares insights into the novel Molecular International Prognostic Scoring System (IPSS-M). Since its release last year, the IPSS-M has been considered more accurate than its predecessor, the IPSS-Revised (IPSS-R), and represents a valuable tool for clinical decision-making and a step forward in achieving personalized therapy for patients. This interview took place at the 65th ASH Annual Meeting and Exposition, held in San Diego, CA.
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Transcript (edited for clarity)
So today I presented something at the session, called ‘are we personalizing MDS therapy in this modern era?’ And my topic encompassed how we’re incorporating molecular markers into both the diagnostic and classification and the prognostication schemes. And so what we learned from all of the work over the probably past 10, 15 years is that the molecular underpinnings of MDS is not only complex, but thankfully somewhat predictable, in that the higher the grade disease, the more mutations that are seen, and that there are particular classes of mutations that appear to both be essential for diagnosis but also be very important in the prognostic setting...
So today I presented something at the session, called ‘are we personalizing MDS therapy in this modern era?’ And my topic encompassed how we’re incorporating molecular markers into both the diagnostic and classification and the prognostication schemes. And so what we learned from all of the work over the probably past 10, 15 years is that the molecular underpinnings of MDS is not only complex, but thankfully somewhat predictable, in that the higher the grade disease, the more mutations that are seen, and that there are particular classes of mutations that appear to both be essential for diagnosis but also be very important in the prognostic setting. And so we’re seeing this revolution in our ability to more accurately give a patient accurate prognosis based on these molecular findings, something that we saw in the 1990s when we first started to incorporate cytogenetic abnormalities, we’re doing the same today with mutations.
And so the new IPSS-M, which was released last year, is now actually much more accurate than the previous version, the IPSS-R, in that the concordance indices are now improved by about 5% for both leukemia-free survival and for overall survival of all the categories of patients. And MDS patients nowadays, with the IPSS-M and the availability of molecular findings, we see that these MDS patients, when they have a new class in their prognosis score, they’re often upgraded or they actually get better separated into an intermediate high and an intermediate low group. So we think that with this improved prognosis that this will lead to better management.
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Disclosures
Invivoscribe: Honoraria.
