IPSS (International Prognostic Scoring System, Greenberg et al, 2002)
Definition of the IPSS
| Score | 0 | 0,5 | 1 | 1,5 | 2,0 |
| Medullary blasts (%) | 0 – 4 | 5 – 10 | – | 11 – 20 | 21 – 29 |
| Number of Cytopenias 1) | 0 – 1 | 2 – 3 | – | – | – |
| Cytogenetic risk group 2) | Low | Intermed. | High | – | – |
1) Platelets < 100.000/µl, Hemoglobin < 10 g/dl, ANC < 1.800/µl
2) Low risk = normal karyotype, 5q-, 20q-, -Y
High risk = complex karyotype (≥ 3 anomalien), chromosom 7-anomalies
Interm. risk = all other aberrations
IPSS-prognostic risk categories
| Score | Risk groups |
| 0 | Low risk |
| 0,5 – 1 | Intermed. risk I |
| 1,5 – 2 | Intermed. risk II |
| ≥ 2,5 | High risk |
IPSS-R (Revised International Prognostic Scoring System, Greenberg et al, 2012)
Definition of the IPSS-R
| Score | 0 | 0,5 | 1 | 1,5 | 2 | 3 | 4 |
| Cytogenetic group 3) | very good | – | good | – | Intermed. | poor | very poor |
| Medullary blasts (%) | < 2 | – | >2–<5 | – | 5–10 | >10 | – |
| Hemoglobin | >10 | – | 8–<10 | <8 | – | – | – |
| Platelets | >100 | 50–<100 | <50 | – | – | – | – |
| ANC | >0,8 | <0.8 | – | – | – | – | – |
3) Very good = del(11q), -Y
Good = normal karyotype, del(20q), del(5q), del(12p), double including del(5q)
Intermediate = +8, del(7q), i(17q), +19, any other single or double independent clone
Poor = -7, inv(3)/t(3q)/del(3q), double including -7/del(7q), complex: 3 abnormalities
Very poor = Complex >3 abnormalities
IPSS-R prognostic risk categories and clinical outcomes
| Score | Risk groups | Survival in years (Medians) |
Time to 25% AML evolution (Medians) |
| 0–1,5 | Very low risk | 8,8 | Not reached |
| 1,5–3 | Low | 5,3 | 10,8 |
| >3–4,5 | Intermed. | 3,0 | 3,2 |
| 4,5–6 | High | 1,6 | 1,4 |
| >6 | Very high | 0,8 | 0,73 |
WPSS (WHO adapted Prognostic Scoring System, Malcovati et al. 2007)
Definition of the WPSS
| Score | 0 | 1 | 2 | 3 |
| WHO Type | RA/RARS/5q- | RCMD/RSCMD | RAEB I | RAEB II |
| Karoytype risk 4) | Low | Intermed. | High | – |
| Transfusion requirements 5) | No one | Regularly | – | – |
4) Low risk = normal karyotype,del (5q),del( 20q), -Y
High risk = complex karyotype (≥ 3 anomalien), chromosom 7-anomalies
Intermediate risk = all other aberrations
5) at least 1 transfusion every 8 weeks over a period of 3 months
WPSS-prognostic risk categories
| Score | Risk groups |
| 0 | Very low risk |
| 1 | Low risk |
| 2 | Intermed. risk |
| 3 – 4 | High risk |
| 5 – 6 | Very high risk |