WAN-HSUAN LEETsai, Ming-TaoMing-TaoTsaiTsai, Cheng-HongCheng-HongTsaiFENG-MING TIENLo, Min-YenMin-YenLoTseng, Mei-HsuanMei-HsuanTsengKuo, Yuan-YehYuan-YehKuoLiu, Ming-ChihMing-ChihLiuYI-TSUNG YANGJUI-CHE CHENJIH-LUH TANGSun, Hsun-IHsun-ISunChuang, Yi-KuangYi-KuangChuangLIANG-IN LINWEN-CHIEN CHOUCHIEN-CHIN LINHSIN-AN HOUHWEI-FANG TIEN2023-08-182023-08-182023-08-092044-5385https://scholars.lib.ntu.edu.tw/handle/123456789/634599Myelodysplastic syndromes (MDS) have varied prognoses and require a risk-adapted treatment strategy for treatment optimization. Recently, a molecular prognostic model (Molecular International Prognostic Scoring System [IPSS-M]) that combines clinical parameters, cytogenetic abnormalities, and mutation topography was proposed. This study validated the IPSS-M in 649 patients with primary MDS (based on the 2022 International Consensus Classification [ICC]) and compared its prognostic power to those of the IPSS and revised IPSS (IPSS-R). Overall, 42.5% of the patients were reclassified and 29.3% were up-staged from the IPSS-R. After the reclassification, 16.9% of the patients may receive different treatment strategies. The IPSS-M had greater discriminative potential than the IPSS-R and IPSS. Patients with high, or very high-risk IPSS-M might benefit from allogeneic hematopoietic stem cell transplantation. IPSS-M, age, ferritin level, and the 2022 ICC categorization predicted outcomes independently. After analyzing demographic and genetic features, complementary genetic analyses, including KMT2A-PTD, were suggested for accurate IPSS-M categorization of patients with ASXL1, TET2, STAG2, RUNX1, SF3B1, SRSF2, DNMT3A, U2AF1, and BCOR mutations and those classified as MDS, not otherwise specified with single lineage dysplasia/multi-lineage dysplasia based on the 2022 ICC. This study confirmed that the IPSS-M can better risk-stratified MDS patients for optimized therapeutic decision-making.en[SDGs]SDG3[SDGs]SDG10journal article10.1038/s41408-023-00894-8375586652-s2.0-85167533498