Comparison of the IPSS and IPSS-R in Predicting Survival and Response of Myelodysplastic Syndrome Patients to 5-Azacitidine
Bibliographic record
Abstract
Background The international prognostic risk score (IPSS) is a validated tool in the prognosis of myelodysplastic syndromes (MDS). Patients who fall into the Int-2 and High categories of the IPSS qualify for treatment with 5-azacitidine, a hypomethylating agent that has been shown to provide a survival advantage with these prognostic risk scores. The IPSS was recently updated, with the newer revised IPSS (IPSS-R) risk score taking into account more cytogenetic data than the IPSS. It has not yet been determined whether the IPSS-R provides an advantage over the IPSS in predicting outcome with 5-azacitidine. The objective of this study was to reclassify a cohort of MDS patients at a single academic center using the IPSS-R, and to determine its ability to predict survival and response to 5-azacitidine. Methods This study was approved by the institutional board review. A total of 97 patients with a diagnosis of MDS were treated with 5-azacitidine at the London Health Science Center up until 2015. Both the IPSS and IPSS-R could be calculated for 77 patients. Kaplan-Meier survival curves were constructed for the patients categorized based on the IPSS and IPSS-R. The scores were also compared based on objective response rates (ORR = complete response + partial response + hematologic improvement) as defined by the IWG 2006 criteria that were determined for all patients. Results All 77 patients included in the study had qualified for 5-azacitidine treatment according to provincial criteria, and had an IPSS score int-2 or high. Upon reclassification using the IPSS-R, 2/77 patients were scored as low, 14/77 patients were scored as intermediate, 24/77 patients were scored as high, and 37/77 patients were scored as very high risk. Kaplan-Meier survival analysis (Figure 1) indicated there was no statistically significant difference between the IPSS-R intermediate, high, and very high survival curves (log-rank p = 0.774). The objective response rate for all 77 patients treated with 5-azacitidine was 23%, with ORR of 21% for IPSS-R intermediate, 17% for IPSS-R high, and 38% for IPSS-R very high. Conclusions The IPSS-R is an alternative prognostic risk scoring system that takes into account additional cytogenetic data compared to the IPSS. In our center the IPSS-R has not resulted in prognostic risk categories that are an improvement over the IPSS in predicting survival in response to 5-azacitidine. The IPSS-R very high risk patients had double the objective response rate to 5-azacitidine compared to the intermediate and high risk groups. Disclosures Lazo-Langner: Bayer: Honoraria; Pfizer: Honoraria; Daiichi Sankyo: Research Funding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".