# IPSS-M outperforms IPSS-R in prognostic stratification and guides effective interventions for very High-Risk myelodysplastic syndrome patients undergoing allogeneic hematopoietic stem cell transplantation

## TL;DR

The IPSS-M system better predicts outcomes for MDS patients after stem cell transplants and helps identify those needing early interventions.

## Contribution

IPSS-M outperforms IPSS-R in identifying high-risk MDS patients who benefit from prophylactic interventions post-transplant.

## Key findings

- IPSS-M reclassified 29.5% of patients to a higher risk group compared to IPSS-R.
- Very-high risk category in IPSS-M was an independent factor for lower survival and higher relapse.
- Prophylactic interventions reduced relapse risk and improved survival in very-high risk patients.

## Abstract

Allogeneic hematopoietic stem cell transplantation represents a curative modality for patients with myelodysplastic syndrome (MDS), yet relapse risk persists. The prognostic performances of the Revised International Prognostic Scoring System (IPSS-R) and the Molecular International Prognostic Scoring System (IPSS-M) for 129 MDS patients undergoing allogeneic peripheral blood stem cell transplantation (allo-PBSCT) were evaluated. Using IPSS-M, 29.5% of patients were reclassified to a higher risk and 14.0% to a lower risk compared to IPSS-R. The two-year recurrence-free survival (RFS) and overall survival (OS) post-transplant were similar across IPSS-R groups, but significantly lower in the very-high risk category with IPSS-M (P = 0.005 for RFS; P = 0.014 for OS). Multivariate analysis revealed that patient age (P = 0.009, P = 0.017), very-high risk category in IPSS-M (P = 0.003, P = 0.001), and KPS score (P = 0.034, P = 0.055) were independent factors for OS and RFS. Only very-high risk category in IPSS-M was the independent factor affecting cumulative incidence of relapse (P = 0.003). Prophylactic interventions for relapse significantly decreased the risk of relapse (P = 0.003) and increased the survival of patients in the very-high risk category (P = 0.002 for OS, P = 0.006 for RFS). The study suggested that the IPSS-M system could identify the high relapse risk patients post-transplant who may benefit from early prophylactic interventions.

The online version contains supplementary material available at 10.1007/s12672-025-03155-1.