Risk Stratification and Recommendations to Mitigate Iron Overload

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Based on the original International Prognostic Scoring System (IPSS), approximately one-third of patients with myelodysplastic syndrome (MDS) will be classified as high risk. These patients have a threat of imminent death, explains Azra Raza, MD. The remaining two-thirds are considered intermediate risk or low risk. Mortality is not an immediate threat for these patients, as only 10% to 15% will ever transition to acute myeloid leukemia.

For lower-risk patients, the major concern centers around quality of life, Raza explains. Most of these patients are older (>65 years), and many will require repeated transfusions. To avoid the iron overload that can result from these transfusions, National Comprehensive Cancer Network (NCCN) and MDS Foundation guidelines recommend iron chelation for low-risk MDS patients. These patients will require emotional and psychological support beyond their usual medical treatments.

However, these classification scoring tools are not always accurate, Raza warns. She believes that the IPSS may provide accurate risk classifications only 50% of the time. The IPSS has since been revised, but time is needed to assess the accuracy of the newer version. While scoring systems can assist in determining risk level, Raza stresses that hematologists should depend on their clinical judgment, based on the natural history of the disease.