Revised International Prognostic Scoring System (IPSS-R) for Myelodysplastic Syndrome (MDS)

• Very low or low risk patients can be observed and given supportive care only with monitoring of blood counts, unless they have another indication for treatment, such as symptomatic cytopenias. If these patients require treatment, they can usually be managed with low-intensity regimens such as growth factors, hypomethylating agents or lenalidomide.
• High or very high risk patients will usually require treatment with high-intensity therapies such as chemotherapy and allogeneic transplant.
• Intermediate patients can be treated with either low- or high-intensity treatments based on age, performance status and patient preference.
• Patients with deletion 5q and up to one other cytogenetic abnormality (as long as it is not del7q) are special cases that are very low risk and respond to lenalidomide. Treatment-related MDS is also a special category that is very high risk.

Treatment decision should be individualized, and since most patients with MDS are older, comorbid conditions should be taken into consideration. An elderly patient with high risk MDS may still be best suited by a hypomethylating agent and/or considered for a reduced intensity allogeneic stem cell transplant.