Baseline IPSS-M vs pretransplant risk downstaging as prognostic determinants in MDS undergoing allogeneic transplantation

Risk stratification in myelodysplastic syndromes myelodysplastic syndromes: (my-eh-lo-diss-PLASS-tik SIN-dromez) A group of disorders where the bone marrow does not work well, and the bone marrow cells fail to make enough healthy blood cells. Myelo refers to the bone marrow. Dysplastic means abnormal growth or development. People with MDS have low blood cell count for at… (MDS) is essential for clinical decision-making, yet the optimal approach to estimate risk for patients undergoing allogeneic stem cell transplantation (alloHSCT) remains uncertain. Whether dynamic changes in risk between diagnosis and post-hypomethylating agent (HMA) therapy improve prognostic accuracy beyond baseline evaluation has not been established. We retrospectively studied 176 HMA-treated patients who underwent alloHSCT, applying the Molecular International Prognostic Scoring System International Prognostic Scoring System: A system that turns patient data into a score. The score tells how quickly a myelodysplastic syndrome (MDS) case is progressing and helps predict what may happen with the patient's MDS in the future. Also called IPSS. (IPSS-M) at both diagnosis and before transplant. The primary end point was 4-year progression-free survival (PFS). Overall, dynamic assessment did not improve prognostic performance compared with baseline evaluation. For 4-year PFS, C-indices at diagnosis vs at alloHSCT were 0.6406 vs 0.6377 (P = .82). Patients with worsening risk after HMA experienced notably inferior outcomes, whereas those with apparent improvement fared no better than patients with unchanged risk (4-year PFS: 50%, 50%, and 31% for improved, unchanged, and worsening risk, respectively). Apparent IPSS-M improvement before alloHSCT yielded no gains in survival and no reduction in relapse relative to unchanged risk, a pattern consistent among TP53 wild-type patients. Moreover, clearance of TP53 mutations after HMA therapy did not translate into improved posttransplant outcomes. In summary, dynamic reassessment with IPSS-M before alloHSCT offers no prognostic advantage over baseline evaluation at diagnosis in HMA-treated patients with MDS. Accordingly, risk reduction should not be regarded as a therapeutic goal or trial end point, whereas risk progression constitutes an adverse marker that may inform incorporation of posttransplant maintenance strategies or intensified conditioning regimens to improve survival.