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How are high risk and low risk myelodysplastic syndromes defined?
Posted by
HealthTree • August 24, 2023
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Learn how high-risk and low-risk myelodysplastic syndromes are defined in this video.
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How are high-risk and low-risk MDS defined? Right, so the way that we do it traditionally is that there's a scoring system that's called the IPSS. It's the International Prognostic Scoring System for MDS. So that's based upon a number of factors. So some of the factors are, what are your blood counts? If they're really low, then you go into a higher category, right? The other is, what are the genetic changes that we see? Do we see specific mutations or do we see specific chromosome abnormalities? And that might put you in one risk group or another. And then one of the other major things are leukemia is represented by actual leukemia, not MDS, is represented by something called blast cells. So those look like leukemia cells, and those can be different proportions in a bone marrow. So they could be like 1% of the cells. That's pretty normal, that you and I have. It could be 100% of the cells, which is truly acute leukemia. So in MDS, like if you're above 20% to 30%, you're not MDS anymore, you're leukemia. But the percentage of those blasts also go into the scoring system. So you get points for certain things, and then there are point cutoffs where you say you have this many points in your low risk, you have this many points in your high risk. So that's how we traditionally separate people out. High and low risk MDS are defined by different scoring systems where we take into account a patient with MDS's blood counts, and then also how involved their bone marrow is with we call blasts, as well as chromosomal changes, which is how the DNA in the MDS cells looks. Some patients have a low scoring system, and we call those lower risk patients. Patients who have a higher score, we call higher risk patients, and we treat them differently. A new scoring system also takes into account the mutations that patients with MDS can have, and allows us to better refine who is low risk and high risk. You can. So you can progress over time from low risk to high risk, and the major feature there that we look at is going to be your blast count. So if you start out with less than 5%, you're going to be in the low risk category. If that blast count increases over time, gets to 10%, 15%, then I think you've now gone into a high risk situation. If you think about it, MDS is not by itself. It's like there's MDS and then there's leukemia past it. Once you get here, it's leukemia, and that requires all hands on deck. That's an emergency. Before you get there, you have all of this MDS to get through. This is especially for elderly patients. And so I think that you want to monitor people over time to see if they're getting close to being more high risk, because that might be a time where you say, look, we should shift your therapy from really focusing on quality of life to now focusing on things that we might want to do that might have a lot of side effects, but might extend the time that you're going to be alive. So that's really a flip, and it's constant monitoring there to try to figure that out.
