What are the different risk groups and what differentiates between them?

What are the different risk groups of MDS and what's the difference between them? So one of the most common questions my patients ask me is what stage is my MDS? And a lot of people have a friend who might have breast cancer, another friend who has lung cancer, and they were given a stage to their diagnosis. Well we don't formally stage myelodysplastic syndromes because if you think about it, it's something that arises in the bone marrow and the bone marrow is throughout our entire body. So if we were to stage it, everyone would be a stage four. It would be ridiculous. Instead, what we use is a system called the International Prognostic Scoring System or IPSS is our default staging system. There's a revised version of that and even a version that incorporates genetic mutations called the IPSS molecular. So in those systems, we look at a person's blood counts and the degree of anemia, low platelet count, or low white blood cell count a person has. We look at the blast percentage in the bone marrow. Blasts are immature white blood cells and if those are 5% or greater, we say that's abnormal. And we look at the genetics of the MDS and use that system to risk stratify people. In general, we divide risk into lower risk MDS and higher risk MDS. Someone who has lower risk MDS is going to live for years with that diagnosis. Someone with higher risk MDS has a much shorter predicted survival and that's why we need to initiate treatment in those people quickly.