IPSS-R (Revised IPSS for MDS)

IPSS-R: The gold standard for de novo MDS prognostic stratification. Weighted for Cytogenetics, Blasts, and Peripheral Cytopenias.

Cytogenetics

Marrow Blasts (%)

Haemoglobin (g/dL)

Platelets (× 10⁹/L)

ANC (× 10⁹/L)

Total IPSS-R Score

0

Risk Category

Very Low

Median Survival: 8.8 yr

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

Initial risk stratification of patients with newly diagnosed Myelodysplastic Syndromes (MDS).

Predicting the risk of transformation to Acute Myeloid Leukemia (AML) and overall survival.

Guiding treatment decisions, such as the timing of stem cell transplantation or therapeutic intervention (e.g., HMAs).

Patient Population

Adult patients with de novo MDS. While validated in older cohorts, its values remain discriminative across age groups.

When Not to Rely on This Score Alone

Secondary or therapy-related MDS (t-MDS) — these patients typically have worse outcomes than predicted by IPSS-R.

MDS with excess blasts > 30% — this is classified as AML in modern systems (WHO 2022 / ICC).

Patients with significant comorbidities — patient fitness should be assessed alongside biological risk.

How it Works

Scoring variables

Factor	Score Points
Cytogenetics	Very Good (0), Good (1), Intermed (2), Poor (3), V. Poor (4)
Marrow Blast %	≤ 2 (0), > 2–5 (1), 5–10 (2), > 10 (3)
Haemoglobin (g/dL)	≥ 10 (0), 8–10 (1), < 8 (1.5)
Platelets (× 10⁹/L)	≥ 100 (0), 50–100 (0.5), < 50 (1)
ANC (× 10⁹/L)	≥ 0.8 (0), < 0.8 (0.5)

Risk Groups (Total Score)

Score	Risk Group	Median Survival (yr)	AML Transformation
≤ 1.5	Very Low	8.8	Never (median)
> 1.5 – 3	Low	5.3	10.8
> 3 – 4.5	Intermediate	3.0	3.2
> 4.5 – 6	High	1.6	1.4
> 6	Very High	0.8	0.73

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

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IPSS-R (Revised IPSS for MDS)

0

Very Low

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Scoring variables

Risk Groups (Total Score)

Clinical Pearls

Cytogenetic Priority

IPSS-M Update

The Evidence

Primary Score

Revised international prognostic scoring system for myelodysplastic syndromes.

Origins & History

Development

In Recent Clinical News

IPSS-R (Revised IPSS for MDS)

0

Very Low

When to Use

When to Use

Patient Population

When Not to Rely on This Score Alone

How it Works

Scoring variables

Risk Groups (Total Score)

Clinical Pearls

Cytogenetic Priority

IPSS-M Update

The Evidence

Primary Score

Revised international prognostic scoring system for myelodysplastic syndromes.

Origins & History

Development

In Recent Clinical News