DIPSS/DIPSS Plus (Dynamic International Prognostic Scoring System) for Myelofibrosis

DIPSS for Myelofibrosis

Age >65 years

Hemoglobin <10 g/dL

WBC >25,000/µL

Circulating Blasts ≥1%

Constitutional Symptoms (weight loss, fever, night sweats)

Score:–

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Estimates survival in patients with primary myelofibrosis.

Why Use

Provides a standardized method for estimating survival in patients with PMF. Helps identify high-risk patients who may benefit from earlier, more aggressive interventions, including allogeneic stem cell transplantation. These tools are particularly useful in settings where molecular data are unavailable.

When to Use

Use in patients with primary myelofibrosis (PMF) to assess prognosis. Appropriate for initial risk stratification at diagnosis and throughout the disease course to reassess prognosis.

Formula

The DIPSS Score and DIPSS Plus Score is calculated by the addition of the selected points: Variable Points DIPSS Score Age >65 years No 0 Yes 1 White blood cell count >25,000 /μL No 0 Yes 1 Hemoglobin <10 g/dL No 0 Yes 2 Peripheral blood blast ≥1% No 0 Yes 1 Constitutional symptoms No 0 Yes 1 DIPSS Plus Score DIPSS Score Low (0) 0 Intermediate-1 (1-2) 1 Intermediate-2 (3-4) 2 High (5-6) 3 Unfavorable karyotype (Complex karyotype or sole or two abnormalities that include 8, 7/7q-, i(17q), 5/5q-, 12p-, inv(3), or 11q23 rearrangement) No 0 Yes 1 Platelets <100,000 /μL No 0 Yes 1 Red cell transfusion dependent No 0 Yes 1

Pearls / Pitfalls

DIPSS Plus should be used when karyotype information is available for more refined risk assessment. DIPSS and DIPSS Plus do not utilize molecular data, which may alter prognosis; alternative prognostic models may be preferred when molecular information is available. Both are dynamic tools that can be applied at any time during the course of PMF.

Advice

Use results in conjunction with clinical judgment and patient preference to guide management care plans and inform goals of care discussions. High and intermediate-2 risk: Consider more aggressive treatments, such as referral to a transplant center for allogeneic stem cell transplantation evaluation, particularly in younger patients with good functional status. Intermediate-1 and low risk: Consider more conservative, symptom-directed treatment with regular follow-up. Results are prognostic, not predictive of treatment response; clinical judgment and specialist consultation remain essential.

More Information

Interpretation: Score Risk Median Overall Survival DIPSS Score 0 Low N/A 1-2 Intermediate-1 14.2 years 3-4 Intermediate-2 4 years 5-6 High 1.5 years DIPSS Plus Score 0 Low 185 months 1 Intermediate-1 78 months 2-3 Intermediate-2 35 months 4-6 High 16 months