Threefold IPSS-M reclassification outperforms original stratification in predicting post-transplant outcomes for MDS patients

The predictive performance of the Molecular International Prognostic Scoring System (IPSS-M) for high-risk myelodysplastic syndromes (MDS) patients undergoing transplantation remains uncertain. We retrospectively analyzed 86 MDS patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) at our center from 2016 to 2023. According to IPSS-M, patients were classified as Low (<i>n</i> = 3), Moderate-Low (<i>n</i> = 9), Moderate-High (<i>n</i> = 15), High (<i>n</i> = 28), and Very-High risk (<i>n</i> = 31). The IPSS-M did not demonstrate good prognostic accuracy for overall survival (OS) (<i>P</i> = 0.227) and disease-free survival (DFS) (<i>P</i> = 0.095) in these 86 patients. We then divided the patients into three groups based on their IPSS-M scores: IPSS-M < 0.56 (<i>n</i> = 28), IPSS-M 0.56-1.75 (<i>n</i> = 30), and IPSS-M>1.75 (<i>n</i> = 28). There was a significant difference in the long-term OS (<i>P</i> = 0.010) and DFS among the three groups (<i>P</i> < 0.001). This indicates that, based on the original IPSS-M scores, we may be able to find a more precise risk stratification for high-risk MDS patients undergoing allo-HSCT. Compared with TP53 wild-type and TP53 monoallelic mutations, TP53 biallelic mutations have a significant negative impact on OS and DFS (<i>P</i> = 0.016, <i>P</i> = 0.006). It is crucial to identify TP53 allelic status at diagnosis to distinguish these patients and determine the need for early involvement in clinical trials.