Frailty and comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms

IPSS-M has improved prognostication in MDS by integrating clinical, cytogenetic, and molecular data. Here, we investigate the potential added value of considering frailty and comorbidity for improving prognosis prediction. Using data from a training set of 412 subjects with newly diagnosed MDS, we develop “Integrated IPSS-M”, a risk-stratification model that recalibrates IPSS-M based on age, frailty, and comorbidity. We then confirm the model’s performance on a validation set of 275 subjects. The Integrated IPSS-M showed higher concordance scores for overall survival compared with the IPSS-M (training set, 0.77 [95-percent confidence interval [CI], 0.73, 0.80] vs. 0.68 [0.64, 0.72], P < 0.001; validation set, 0.73 [0.68, 0.78] vs. 0.69 [0.64, 0.74], P = 0.03). Our study indicates that integration of IPSS-M, age, frailty, and comorbidity enhances prognostic accuracy in MDS. These findings suggest that Integrated IPSS-M may inform treatment decision-making and trial enrollment for new therapies.