WPSS (WHO classification-based Prognostic Scoring System) for Myelodysplastic Syndrome

WPSS Calculator

WHO Classification

Karyotype

Transfusion Requirement

WPSS Score: –

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Evaluates prognosis of patients with myelodysplastic syndrome (MDS).

Why Use

Stratifies patients into risk categories that correlate with overall survival and the likelihood of progression to acute myeloid leukemia. Aids clinicians in choosing therapeutic strategies (e.g., supportive care, disease-modifying therapy, consideration for transplant). Unlike some similar models, this tool has been validated for use throughout the disease course.

When to Use

Calculate at diagnosis of myelodysplastic syndrome (MDS) to aid in initial risk stratification. Can be applied as part of ongoing monitoring to reassess the patient’s risk category over time or whenever there is a change in clinical status.

Formula

Addition of the selected points: Prognostic variable 0 points 1 point 2 points 3 points WHO category Refractory anemia (RA), refractory anemia with ringed sideroblasts (RARS), or myelodysplastic syndrome with isolated del (5q) Refractory cytopenia with multilineage dysplasia (RCMD), or refractory cytopenia with multilineage dysplasia and ringed sideroblasts (RCMD-RS) Refractory anemia with excess of blasts, 2-4% blasts in peripheral blood (RAEB-1) Refractory anemia with excess of blasts, 5-19% blasts in peripheral blood (RAEB-2) Karyotype* Good Intermediate Poor -- Transfusion requirement** None Regular -- -- *Karyotype is defined as follows: good = normal, –Y, del(5q), del(20q); poor = complex (≥3 abnormalities), chromosome 7 anomalies; and intermediate = all other abnormalities. **Transfusion requirement is defined as having at least one RBC transfusion every 8 weeks over a period of 4 months.

Pearls / Pitfalls

This tool transfusion requirements, which may be influenced by local practice patterns. Accurate scoring requires familiarity with WHO subgroups.

Management

Low- or very low-risk: Asymptomatic patients may be appropriate for monitoring and supportive measures (e.g., transfusions). Low-intensity therapies (e.g., growth factors, hypomethylating agents, luspatercept, lenalidomide, immunosuppressives, and targeted agents) may be considered if symptomatic. More intensive therapy can be offered to younger, fit patients based on clinical circumstances and pathologic features. High- or very high-risk: Therapy choice often depends on the patient’s medical fitness and pathologic features. Options can include: Low-intensity therapies listed above (e.g., hypomethylating agents, targeted therapies). High-intensity therapies, such as chemotherapy with or without allogeneic hematopoietic cell transplantation (HCT).

Advice

Management should be guided by clinician expertise, the patient’s overall clinical scenario, and individual preferences. MDS can evolve; frequent re-evaluation is recommended if clinical status changes or new data become available.

More Information

Interpretation: WPSS Score Risk Group Median Survival 0 Very low 141 months 1 Low 66 months 2 Intermediate 48 months 3-4 High 26 months 5-6 Very high 9 months