Prognostication in myelodysplastic syndromes (neoplasms): Molecular risk stratification finally coming of age

Accurate risk prognostication is central to the management of myelodysplastic syndromes, given the widely heterogeneous clinical outcomes of these bone marrow failure disorders. Over the past decade, the rapidly expanding compendium of molecular lesions in myelodysplastic syndrome (MDS) has offered unprecedented insight into MDS pathobiology. Recently, molecular prognostic models such as the Molecular International Prognostic Scoring System (IPSS-M) have leveraged the wellspring of genetic data to improve upon traditional risk models such as the Revised IPSS (IPSS-R), but also added substantial complexity. In this review, we highlight early MDS prognostic models, the significant advancements in MDS genomics since then, and the recent advent of molecular based prognostic models. We conclude by discussing important opportunities and challenges in the management of MDS as we arrive at the molecular frontier.

Automated summary

Accurate risk prognostication is crucial for managing myelodysplastic syndromes (MDS) due to their diverse clinical outcomes. Advances in MDS genomics have provided unprecedented insight into MDS pathobiology, leading to the development of molecular prognostic models. These models, such as the IPSS-M, improve risk prediction but also introduce complexity. This review discusses early MDS prognostic models, recent advancements in MDS genomics, and the challenges and opportunities at the molecular frontier.