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The Revised International Prognostic Scoring System (IPSS-R) calculator for myelodysplastic syndrome evaluates several clinical parameters to determine a patient's prognosis, providing both a numerical score and an interpretation of their risk group and median survival. The input parameters analyzed by the calculator are:

1. Cytogenetic group
2. Medullary blasts percentage
3. Hemoglobin levels in g/dL
4. Platelet count per mm³
5. Absolute neutrophil count per mm³

Each of these inputs is assigned a score based on specific criteria, which are then summed to yield a total prognostic score. The scoring system for each input is detailed as follows:

- Cytogenetic group scores range from 0 to 4 based on the complexity and nature of chromosomal abnormalities.
- Medullary blasts percentage is scored from 0 to 3 depending on the percentage of blasts present.
- Hemoglobin levels are scored as 0, 1, or 1.5 depending on the concentration of hemoglobin.
- Platelet count is scored as 0, 0.5, or 1 based on the number of platelets per mm³.
- Absolute neutrophil count scores are either 0 or 0.5, determined by the neutrophil count.

The cumulative score is computed by summing the individual scores associated with each input parameter. This total score, ranging from 0 to a maximum of 10, is used to categorize patients into distinct risk groups, each associated with a different median survival expectation:

- A score of 1.5 or below indicates a "Very low risk group" with a median survival of 8.8 years.
- A score between 1.5 and 3 falls into the "Low risk group" with a median survival of 5.3 years.
- A score between 3 and 4.5 corresponds to an "Intermediate risk group" with a median survival of 3 years.
- Scores between 4.5 and 6 designate the "High risk group" with a median survival of 1.6 years.
- Any score above 6 places the patient in the "Very high risk group," with a median survival of 0.8 years.

The Revised International Prognostic Scoring System (IPSS-R) is a clinical calculator used specifically for patients diagnosed with myelodysplastic syndrome (MDS). The IPSS-R is an updated version of the original International Prognostic Scoring System (IPSS), and it provides a more accurate risk stratification of MDS patients. 

The IPSS-R is used to predict the overall survival and risk of transformation to acute myeloid leukemia (AML) in patients with MDS. It takes into account five different factors: cytogenetics, bone marrow blast percentage, and levels of hemoglobin, platelets, and absolute neutrophil count. 

The IPSS-R is not applicable to patients with therapy-related MDS or those who have already progressed to AML. It is also less accurate in patients who have received prior treatment for MDS. The IPSS-R is a valuable tool for clinicians to guide treatment decisions and discuss prognosis with patients.

Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndrome

The International Prognostic Scoring System (IPSS) for myelodysplastic syndrome provides an assessment of a patient's prognosis by analyzing three key inputs: cytogenetic abnormalities, medullary blast percentage, and the number of cytopenias. Each of these factors is assigned a score that accumulates to form an overall risk score.

For the cytogenetic group:

- Normal karyotype, del5q), del20q) = 0 points
- ≥ 3 abnormalities or abnormal chromosome 7 = 1 point
- Other abnormalities = 0.5 points

In terms of medullary blasts percentage:

- ≤ 5% = 0 points
- 5-10% = 0.5 points
- (Note: The option for 11-20% is not explicitly included in the inputs but would logically align with a higher score)
- 21-30% = 2 points

For the number of cytopenias (considering anemia, neutropenia, and thrombocytopenia):

- None or 1 = 0 points
- 2 or 3 = 0.5 points

The total score is calculated by summing the points from each of the input categories. Based on this total score, the interpretation of risk is categorized as follows:

- A total score of 0 suggests a low risk.
- Scores ranging from 0.5 to 2 indicate an intermediate risk level.
- A score of 2.5 or above signifies a high risk of myelodysplastic syndrome progression.

This tool systematically guides healthcare providers in assessing the risk profile of a patient with myelodysplastic syndrome, thereby aiding in the management and therapeutic decisions.

The International Prognostic Scoring System (IPSS) is a clinical calculator used for the prognosis of patients with myelodysplastic syndrome (MDS). MDS is a group of disorders characterized by poorly formed blood cells or cells that do not work properly. The IPSS is used to predict the risk of progression to acute myeloid leukemia (AML) and overall survival in newly diagnosed MDS patients. 

The IPSS takes into account factors such as the number of cytopenias (low counts of one or more types of blood cells), the percentage of bone marrow blasts (immature cells), and the type of chromosomal abnormalities. Based on these factors, patients are categorized into four risk groups: low, intermediate-1, intermediate-2, and high. 

The IPSS is not applicable to patients with secondary MDS (MDS that develops as a result of treatment for another disease or exposure to certain chemicals), or those who have already progressed to AML. It is also less accurate in patients who have received prior therapy for MDS.

International Prognostic Scoring System (IPSS) for prognosis of myelodysplastic syndrome

The Eastern Cooperative Oncology Group (ECOG) performance status calculator is designed to evaluate a patient's functional ability and categorize it into a specific score from 0 to 5. This quantitative measure helps clinicians make informed decisions about treatment based on the patient's capacity for daily activities and self-care. Here's how it operates:

The user provides input by selecting the description that best matches the patient's current condition from a list of predefined options. These options encapsulate various levels of activity and ability:

- A patient who is "Fully active, able to carry on all pre-disease performance without restriction" is assigned a score of ECOG PS 0. This indicates that the patient is not limited in any capacity by their disease.
- If a patient is "Restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework, office work," they receive an ECOG PS 1. This means the patient can perform some self-care and work activities but faces restrictions with strenuous tasks.
- "Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours" corresponds to an ECOG PS 2. This reflects moderate impairment, where the patient is active for the majority of the day but not capable of work activities.
- A patient who is "Capable of only limited self-care, confined to bed or chair more than 50% of waking hours" gets an ECOG PS 3. This score denotes significant limitation, as the patient is mobile for less than 50% of the time and requires assistance for most activities.
- With "Completely disabled, cannot carry on any self-care, totally confined to bed or chair," the patient is categorized as ECOG PS 4, indicating severe impairment and complete dependency.
- Finally, if the patient is "Dead," they are assigned an ECOG PS 5.

These score assignments help standardize assessments, providing an objective measure of a patient's status which can be pivotal in guiding medical decisions and evaluating treatment options.

The Eastern Cooperative Oncology Group (ECOG) performance status, also known as the ECOG score, is a widely used tool in oncology to assess a patient's level of functioning in terms of their ability to care for themselves, daily activity, and physical ability (walking, working, etc.). It is applicable to patients with cancer of any type and at any stage.

The ECOG score ranges from 0 to 5, with 0 indicating fully active and able to carry on all pre-disease activities without restriction, and 5 indicating death. The score is used to determine a patient's prognosis, assess how a disease is progressing, and to determine appropriate treatment strategies. It is also often used in clinical trials to assess eligibility and to monitor patient progress.

There are no specific exclusion criteria for the use of the ECOG score, but it is important to note that it is a subjective measure and may not fully capture a patient's functional status. It is also less useful in patients with fluctuating or rapidly changing conditions.

Eastern Cooperative Oncology Group performance status (ECOG score)

The Karnofsky Performance Scale (KPS) provides a practical method to evaluate a patient's functional ability and the extent of care required based on their health status. The scale ranges from 0% to 100%, where higher percentages signify better functional capacity and health.

This tool involves selecting a descriptive statement that best reflects a patient's current condition from a predefined list. Each statement is connected to a specific KPS percentage that indicates the patient’s ability to perform daily activities and their dependency levels. Here’s how the assessment works:

- When a patient is described as "Normal, no complaints, no evidence of disease," this is assessed as KPS 100%. At this level, the individual can engage in all regular activities, including work, without needing special care.

- If a patient can "carry on normal activity" but exhibits "minor signs or symptoms of disease," they are scored at KPS 90%, indicating the capability to maintain routine activities without requiring special care.

- A description of "Normal activity with effort, some signs or symptoms of disease" aligns with KPS 80%. This suggests the patient can still carry out normal activities but might require some extra effort.

- When the condition reflects "Cares for self, unable to carry on normal activity or to do active work," it corresponds to KPS 70%. The patient can handle most personal needs independently but may need occasional assistance.

- "Requires occasional assistance but is able to care for most personal needs" is rated as KPS 60%, implying increased dependency on assistance though the patient remains mostly self-sufficient.

- At KPS 50%, for conditions described as "Requires considerable assistance and frequent medical care," the patient can live at home but needs considerable help with personal care.

- As the need for care intensifies, with descriptions like "Disabled, requires special care and assistance," the KPS drops to 40%. This marks a significant deterioration in self-care ability.

- "Severely disabled, hospital admission is indicated, death not imminent" corresponds to KPS 30%, highlighting a need for hospitalization without immediate life-threatening conditions.

- For those "Very sick," necessitating hospital admission and "active supportive treatment," the KPS is 20%, indicating critical care requirements.

- At KPS 10%, "Moribund" denotes an inability to care for oneself, with urgent need for hospital-level care and a poor prognosis.

- Lastly, "Dead" is considered as KPS 0%.

This scale is instrumental in providing a quick overview of a patient's ability to function independently and their need for medical support, thereby facilitating better care planning and resource allocation.

The Karnofsky Performance Status Scale (KPSS) is a clinical calculator used primarily in patients with cancer. It is a simple, numerical scale that measures a patient's functional status, ability to perform daily activities, and overall quality of life. The KPSS ranges from 0 (indicating death) to 100 (indicating perfect health). 

The clinical utility of the KPSS is to assess a patient's prognosis, determine appropriate treatment strategies, and monitor changes in a patient's condition over time. It is particularly useful in oncology for determining eligibility for certain treatments, such as chemotherapy or surgery, and for predicting survival outcomes. 

There are no specific exclusion criteria for the use of the KPSS. However, it is less useful in patients with non-cancer illnesses or in those with cognitive impairment who may not be able to accurately self-report their functional status.

Karnofsky Performance Scale

The Modified Glasgow Prognostic Score (mGPS) is a key tool in predicting cancer outcomes, relying on the assessment of two biochemical markers: C-reactive protein (CRP) and albumin. This score helps to categorize the prognosis into three levels: good, intermediate, and poor.

To compute the mGPS:

- C-reactive protein is evaluated first. Two options are considered:  
  - If the CRP is less than or equal to 10 mg/L, it indicates lower systemic inflammation.
  - If the CRP is greater than 10 mg/L, it signifies higher inflammation levels.

- Albumin is the second marker, with two possibilities:  
  - An albumin level of less than 3.5 g/dL [35 g/L] suggests malnutrition or potential inflammatory conditions.
  - An albumin level equal to or greater than 3.5 g/dL [35 g/L] signifies a normal nutritional status and protein reserves.

The mGPS score is derived based on the following systematic interpretation:

- If CRP is <= 10 mg/L, regardless of the albumin level, the score is mGPS 0, corresponding to a good prognosis. This combination indicates a low level of inflammation, which is a favorable signal in cancer outcomes.
 
- If CRP is > 10 mg/L and albumin is >= 3.5 g/dL [35 g/L], the score is mGPS 1, associated with an intermediate prognosis. This combination suggests elevated inflammation yet with sufficient nutritional status, resulting in a moderate outlook.

- If CRP is > 10 mg/L and albumin is < 3.5 g/dL [35 g/L], the result is mGPS 2, indicating a poor prognosis. This reflects high inflammation levels coupled with low albumin, suggesting a more severe condition.

Here's a concise summary table for reference:

| C-reactive Protein | Albumin               | mGPS Score | Interpretation          |
|---------------------|-----------------------|-------------|-----------------------|
| <= 10 mg/L          | < 3.5 or >= 3.5 g/dL  | 0           | Good prognosis         |
| > 10 mg/L           | >= 3.5 g/dL           | 1           | Intermediate prognosis |
| > 10 mg/L           | < 3.5 g/dL            | 2           | Poor prognosis         |

This systematic approach enables healthcare providers to improve risk stratification in cancer patients, allowing for more tailored treatment planning.

The Modified Glasgow Prognostic Score (mGPS) is a clinical calculator used in the field of oncology to predict the prognosis of patients with cancer. It is applicable to a wide range of cancer types and stages, making it a versatile tool for clinicians. The mGPS is based on two simple, routinely measured inflammatory markers: C-reactive protein (CRP) and albumin levels. 

The clinical utility of the mGPS lies in its ability to stratify patients into different risk groups based on their inflammatory response to cancer. This can guide clinicians in making decisions about treatment strategies and follow-up plans. It can also provide valuable prognostic information to patients and their families.

There are no specific exclusion criteria for the use of the mGPS. However, it should be noted that the score may not be as accurate in patients with concurrent inflammatory or infectious conditions, as these can also affect CRP and albumin levels. Additionally, the mGPS may not be applicable to patients with rare types of cancer or those with very early or very advanced disease, as it has not been extensively validated in these groups.

Modified Glasgow Prognostic Score for cancer outcomes (mGPS)

Myelodysplastic syndrome

Stem cell transplantation

Stem cell transplantation (management of donor-specific anti-HLA antibodies, prevention)

Lenalidomide

Erythropoiesis-stimulating agents

ESAs

Stem cell transplantation (management of donor-specific anti-HLA antibodies, testing)

Platelet transfusion

Stem cell transplantation (post-transplant management)

As per BMT CTN/EBMT/ELN/IMDSF 2017 guidelines, 

Myelodysplastic syndrome

Guidelines

Key sources