Marrowforums.org: MDS Classification

MDS Classification Tool

About MDS Classification

MDS is a family of diseases, categorized by doctors and researchers into subtypes according to one or more classification schemes: the International Prognostic Scoring System (IPSS), its revised version (IPSS-R), the WHO (World Health Organization) Classification System (WPSS), and the older FAB (French American British) Classification System. You may find any of them referenced in medical literature. For more information about MDS and its subtypes, see MDS Classification.

You can use this tool to understand how MDS classification works, to identify your score or subtype under five MDS classification schemes, and to study how different input data affects the classifications.

Important! The MDS Classification Tool can help you learn more about your health and identify questions to ask your doctor. Tools like this must not be used to make your own diagnostic or treatment decisions or to replace medical consultations. We recommend that you confirm your subtype with your doctor and ask your doctor what it means for your health and treatment.

Filling in Your Data

Follow these steps:

Read the instructions and cautions below.
Fill in the fields on the My Data tab with information from your blood and bone marrow tests.
Find the results on the IPSS, IPSS-R, WHO, WPSS, and FAB tabs.

If you don't have the necessary data to enter, you can ask for test results from your doctor or treatment center. Lab reports from a bone marrow biopsy use medical terminology that is meant for doctors. Ask your doctor to go over the results with you.

What This Tool Shows You

The purpose of MDS classification systems

These systems were created by doctors and researchers to help guide treatment choices.

Using statistical analysis, doctors sorted MDS patients into groups with similar disease outcomes, then defined the groups so that others could use the same classifications.

This tool will help you identify or understand how you fit into each classification system. On each tab you'll see your score and/or subtype, if one applies, and statistics about patients in that category. You'll also see an explanation of how each score was computed.

Median survival

This statistic is the time that elapsed before only 50% of the patients in the study group were still living.

For example, if the median survival is 5 years 8 months, it means that half of the studied patients lived for less than 5 years 8 months after diagnosis, while the other half lived longer.

Depending on the classification system, you may also see median survival over patients in a certain age range.

Median 25% AML progression

This statistic is the time that elapsed before a quarter of MDS patients changed to a diagnosis of AML.

For example, if the median 25% AML progression is 10 years 10 months, it means that one fourth of the studied patients had AML after 10 years 10 months, and the other three fourths did not.

Depending on the classification system, you may see the percentage of MDS patients who progress to AML eventually, or within 2 years.

Do the Results Apply to Me?

It is the nature of statistics that they can be used to predict average outcomes for large groups of patients but not for any individual patient. Your subtype may be precisely determined, but your prognosis is not. Statistics give you only a relative idea of your risk level.

The statistics you see in these charts are grim, reflecting the life-threatening nature of MDS if left untreated. However, there are a number of mitigating factors you should keep in mind:

The defintion of "median survival" means that half of patients outlive the median.
The definition of "median 25% AML progression" means that three quarters of patients do not have AML after that time.
The data used to create these MDS classification systems was collected from patients with de novo (not secondary) MDS who had not received intensive chemotherapy, so they apply most closely to patients in similar circumstances. The WPSS score is intended to apply throughout a program of treatment, while IPSS and IPSS-R are applied at time of diagnosis.
Survival rates increase each year due to medical advances. These statistics were collected from patients in past years, some decades old, so today's results would be more positive.
The statistics are for patients without MDS-specific drug treatment (such as Vidaza) and who did not have transplants. See Treatment of MDS. You may have many choices other than "wait and watch."
Statistics apply to groups of patients but do not indicate your personal prognosis; every patient is different.

Questions and Answers

What do "de novo" and "secondary" mean?

"Secondary" means that prior to your MDS diagnosis you had been treated with radiation and/or chemotherapy for another type of cancer, which may be a cause of your MDS. Secondary MDS is also called treatment-releated or therapy-related. "De novo" is the opposite, meaning that you had no prior radiation or chemtherapy. The cause of de novo MDS is often unknown.

Why don't I have a classification?

Either you haven't filled in all of the necessary fields on the My Data tab or you don't fit the criteria for one or more of the MDS classification systems. For example, you won't have an FAB subtype if you don't have cell dysplasia in your bone marrow.

Why did I get a different classification than last time?

Your lab test results (especially blood counts) can vary from test to test, so you might cross from one subtype to another. It can also reflect treatment success or a progression of the disease. For example, patients whose MDS progresses to leukemia will find that reflected in their WHO classification.

Why do I see different prognosis statistics from one classification system to another?

The survival and AML progression statistics differ from one classification system to the next because they are based on different criteria, and becaue they were derived from different collections of patient data during different periods of time.

Disclaimer

Marrowforums has done its best to make this tool reflect the formulas and data from the cited medical sources, but cannot guarantee that the calculations are error-free. We suggest that you compare your results with other sources and consult your doctor.

Filling in Your Data

Choose the best answer in each category. The circled letters ⒾⓇⓡⓌⓈⒻ tell you which answers are needed for which classifications. Click the underlined questions to learn more about the factors that affect MDS classification. Watch for messages, explanations, or cautions that appear in red. If your test results are on the border between two choices, try them both to see how that affects your subtype.

• Where do I get the information to fill in this form?

Blood count findings:

A routine blood test called a Complete Blood Count (CBC) measures your red blood cell (RBC) count, hemoglobin (HGB), white blood cell (WBC) count, platelets, and many other types of blood components. Different labs use different measurements. For example, you may see your platelet count listed as 200,000 or as 200.

Your monocyte count is shown in a separate test called a "white cell differential."

Auer rods are found in a microscopic analysis of your blood. Serum ferritin, serum LDH, and serum beta-2 microglobulin are also measured with blood tests.

You can ask for copies of your results each time one of these tests is performed.

Bone marrow findings:

Your bone marrow is examined with a bone marrow biopsy and aspiration. A specialist will examine the extracted biopsy and aspirate microscopically to study the number and shapes of your cells and chromosomes and give a report to your doctor. You're entitled to a copy.

If you don't have the information needed to fill out this form, make a list of what you'd like to ask your doctor about your test results. If you can't compute your IPSS-R score, you may still be able to compute your IPSS score, which requires less information. CLOSE

▼ ▶ Blood Findings	Ⓘ required for IPSS score Ⓡ required for IPSS-R scores ⓡ refines IPSS-R survival score Ⓦ required for WHO classification	Ⓢ required for WPSS score Ⓕ required for FAB classification ⭐ normal adult

Hemoglobin (HGB) Ⓘ Ⓡ Ⓦ Ⓢ Ⓕ • What is hemoglobin? Red blood cells are created in your marrow, then enter your circulating blood. They carry hemoglobin, an iron-rich protein that transports oxygen to the body. Both your red blood cell (RBC) count and your hemoglobin (HGB) count are measured in a Complete Blood Count (CBC) test. CLOSE less than 8 g/dL at least 8 g/dL but less than 10 g/dL 10 g/dL or more ⭐ don't know Note: In units of g/L, these cutoff values are 80 g/L and 100 g/L. Absolute neutrophil count (ANC) Ⓘ Ⓡ Ⓦ Ⓢ Ⓕ • What is your ANC? Your Absolute Neutrophil Count (ANC) is an estimate of the number of infection-fighting white blood cells in your blood. Knowing your ANC can help you and your doctor assess your risk of infection. The Marrowforums ANC Calculator will compute your ANC from the results shown on your "differential" lab report. CLOSE less than 800 cells/µL 800 cells/µL or more but less than 1500 cells/µL 1500 cells/µL or more but less than 1800 cells/µL 1800 cells/µL or more ⭐ don't know Platelet count Ⓘ Ⓡ Ⓦ Ⓢ Ⓕ • What are platelets? Platelets are blood cells that are created in your marrow, then enter your circulating blood. They stick together to seal cuts and stop bleeding. CLOSE less than 50,000/µL at least 50,000/µL but less than 100,000/µL 100,000/µL or more ⭐ don't know Auer rods in circulating blood Ⓦ Ⓢ • What are Auer rods? Auer rods are rod-shaped structures in the blood or marrow, composed of crystallized granules. They are an abnormality. CLOSE no Auer rods present ⭐ Auer rods present don't know Transfusions Ⓢ at least one blood transfusion every 8 weeks over the past 4 months fewer or no blood transfusions ⭐ don't know	Blasts in circulating blood Ⓦ Ⓢ Ⓕ • What are blasts? Blasts are immature white blood cells that are normally found in your bone marrow. In MDS, blasts may occur in higher numbers. They may also be found in circulating (peripheral) blood, which is the measurement you enter here. CLOSE less than 1% ⭐ 1% to 4% 5% to 19% more than 19% don't know Monocyte count Ⓦ Ⓢ Ⓕ • What are monocytes? • What do the units "1 x 10⁹/L" and "1000 x 10⁹/µL" mean? Monocytes are white blood cells that ingest foreign particles and dead or worn-out cells. CLOSE Different labs use different units when measuring monocytes and other blood counts. 1 x 10⁹/L means one monocyte for every 10⁹ liters. That's the same as 1000 x 10⁹/µL, meaning 1000 monocytes for every 10⁹ microliters. CLOSE less than 1 x 10⁹/L 1 x 10⁹/L or more ⭐ don't know Serum ferritin ⓡ • What is Ferritin? Ferritin is a protein that stores iron. A high level of ferritin in the blood indicates a buildup of excess iron in the body. CLOSE 350 ng/ml or less ⭐ higher than 350 ng/ml don't know Serum LDH ⓡ • What is LDH? LDH (lactate dehydrogenase) is an enzyme that processes sugar. A high level can indicate tissue damage. Serum LDH is measured in U/L (units/liter), with the upper end of the normal range at about 333 U/L, depending on the lab. CLOSE Normal ⭐ High don't know Serum beta-2 microglobulin ⓡ • What is beta 2-microglobulin? Beta 2-microglobulin is a very small protein, present on all cells with a nucleus. A high level can indicate increased disease activity. CLOSE 2 mg/l or less ⭐ higher than 2 mg/l ⇧ Back to Top don't know

▼ ▶ Bone Marrow Findings	Ⓘ required for IPSS score Ⓡ required for IPSS-R scores Ⓦ required for WHO classification	Ⓢ required for WPSS score Ⓕ required for FAB classification ⭐ normal adult

Chromosomes Ⓘ Ⓡ Ⓢ • What are chromosomes? • How are abnormalities identified? Chromosomes are DNA structures that reside in your cells. Normal human cells have 46 chromosomes, 1 pair each of 23 types. One pair are sex chromosomes called X and Y. The other 22 pairs are autosomes numbered 1 through 22, i.e., chromosome 1, chromosome 2, etc. CLOSE The cytogenetic analysis of your chromosomes after a bone marrow aspiration, usually performed in conjunction with a bone marrow biopsy, will identify the number and shapes of your cells and chromosomes. Lab reports from a bone marrow biopsy use medical terminology that is meant for doctors. Ask your doctor to go over the results with you. CLOSE Error: If you have chromosomal abnormalities, check "some abnormalities found." If you do not have chromosomal abnormalities, do not check any of the abnormality checkboxes. CLOSE all chromosomes normal ⭐ some abnormalities found Check all that apply: inv(3) and t(3q) and del(3q) — three specific problems with chromosome 3 del(5q) — loss of the long arm of chromosome 5 (5) — any other abnormality of chromosome 5 del(7q) — loss of the long arm of chromosome 7 -7 — loss of chromosome 7 (7) — any other abnormality of chromosome 7 +8 — extra chromosome 8 del(11q) — loss of the long arm of chromosome 11 del(12p) — loss of the short arm of chromosome 12 inv(17q) — inversion of the long arm of chromosome 17 +19 — extra chromosome 19 del(20q) — partial loss of chromosome 20 (20) — any other abnormality of chromosome 20 -Y — loss of the Y chromosome 1 other chromosome abnormality not listed above 2 other chromosome abnormalities not listed above 3 or more other chromosome abnormalities not listed above 4 or more other chromosome abnormalities not listed above don't know	Blasts in bone marrow Ⓘ Ⓡ Ⓦ Ⓢ Ⓕ • What are blasts? • How are blasts measured? Blasts are immature blood cells that form in your marrow. In MDS, blasts may occur in higher numbers. That's the measurement you enter here. CLOSE The blast count in your bone marrow is measured by a bone marrow aspiration, usually performed in conjunction with a bone marrow biopsy. CLOSE 0% to 2% ⭐ 3% to 4% ⭐ 5% to 9% 10% 11% to 19% 20% 21% to 30% more than 30% don't know Dysplasia Ⓦ Ⓢ Ⓕ • What does dysplasia mean? Dysplasia means that a particular type of cell is misshapen or the wrong size, as seen in your bone marrow aspiration results, usually performed in conjunction with a bone marrow biopsy and identified in the resulting lab report. You must have at least one cell line with dysplasia to have WHO and FAB subtypes.CLOSE Check all that apply. immature red blood cells (erythrocytes) show dysplasia affecting at least 10% of red cells immature white blood cells (granulocytes) show dysplasia affecting at least 10% of white cells immature platelet cells (megakaryocytes) show dysplasia affecting at least 10% of platelets with hypolobated (poorly shaped) nuclei Ringed sideroblasts Ⓦ Ⓢ Ⓕ • What are ringed sideroblasts? Sideroblasts are immature red blood cells (erythrocytes) containing iron granules. Ringed sideroblasts are abnormal sideroblasts with a ring around the nucleus. They may be reported on the lab report from your bone marrow biopsy and aspiration. CLOSE 15% or less ⭐ more than 15% don't know Auer rods in bone marrow Ⓦ Ⓢ • What are Auer rods? Auer rods are rod-shaped structures in the blood or marrow, composed of crystallized granules. They are an abnormality. They may be reported on the lab report from your bone marrow biopsy and aspiration. CLOSE no Auer rods present ⭐ Auer rods present ⇧ Back to Top don't know

▼ ▶ Age and Abilities	ⓡ refines IPSS-R survival score	⭐ normal adult

Age ⓡ • Why does my age matter? Age is a statistical factor for MDS survival but not statistically significant for progression to AML. CLOSE Age at diagnosis Error: Age value is invalid. CLOSE Warning: The MDS Classification Tool is based on statistics for adults, age 16 and older, not for children. A pediatric hematologist would be a better source of prognostic information. See also Myelodysplastic Syndromes in Children (2007). CLOSE Warning: Age is higher than our formulas are designed to handle. CLOSE
Abilities and limitations ⓡ • What's this? This scale, called an ECOG score, is a simple measure of your overall health status. It is a statistical factor for MDS survival but not statistically significant for progression to AML. If no choice is exactly right, choose the closest choice. If you don't select a choice, we'll use other measures. CLOSE I am fully active and able to carry on all pre-disease activities without restriction. ⭐ I am restricted in physically strenuous activity but ambulatory and able to carry out work of a light or sedentary nature, such as light housework or office work. I am ambulatory and capable of all self care but unable to carry out any work activities. I am up and about more than 50% of my waking hours. I am capable of only limited self-care. I am confined to bed or a chair 50% or more of my waking hours. I am completely disabled. I cannot perform any self-care. I am totally confined to bed or a chair. ⇧ Back to Top not yet selected

To reset the form and clear all choices, reload this page or click the Clear Form button at the top.

Your IPSS Score	If you have an IPSS score we'll explain how it was computed. To see your IPSS score, fill in the information marked Ⓘ on the My Data tab. IPSS scores do not apply when your Blasts in bone marrow are more than 30%.
Your IPSS Classification	Your IPSS classification is determined by your IPSS score.
Statistics	Source: American Cancer Society (1997 data)

IPSS Category	Point Range	Median Survival Across All Ages †	Median Survival for Age 60 and Younger †	Median Survival for Over Age 60 †
Low-risk	0	5 years 8 months	11 years 10 months	4 years 10 months
Intermediate-1	0.5 to 1	3 years 6 months	5 years 2 months	2 years 8 months
Intermediate-2	1.5 to 2	1 year 2 months	1 year 10 months	1 year 1 month
High-risk	2.5 to 3.5	5 months

† See the Instructions tab for the definition of median survival and why survival times are likely to be longer than shown here.

IPSS-R for Survival

Your basic IPSS-R Score	If you have an IPSS-R score we'll explain how it was computed. To see your IPSS-R score for survival, fill in the information marked Ⓡ on the My Data tab. Also fill in the information marked ⓡ, which will refine your score for survival.
Your basic IPSS-R Classification	Your IPSS-R classification is determined by your IPSS-R score.
Statistics	Source: Revised international prognostic scoring system for myelodysplastic syndromes (Blood 120:2454-65, 2012)

You have more than one IPSS-R classification for survival statistics beause researchers computed statistics for each contributing factor separately (ferritin, LDS, beta-2 microglobulin, age, and abilities). No statistics are available on the combinations of factors, so we show you the classification for each factor.

IPSS-R Category	Point Range	Median Survival †
Very low	negative to 1.5	8 years 10 months
Low	1.6 to 3	5 years 4 months
Intermediate	3.1 to 4.5	3 years
High	4.6 to 6	1 year 7 months
Very high	6.1 to 11	10 months

IPSS-R for AML Progression

Your IPSS-R Score	If you have an IPSS-R score we'll explain how it was computed. To see your IPSS-R score for AML progression, fill in the information marked Ⓡ on the My Data tab.
Your IPSS-R Classification	Your IPSS-R classification is determined by your IPSS-R score.
Statistics	Source: Revised international prognostic scoring system for myelodysplastic syndromes (Blood 120:2454-65, 2012)

IPSS-R Category	Point Range	Median 25% Progression to AML †
Very low	0 to 1.5	Not measurable
Low	2 to 3	10 years 10 months
Intermediate	3.5 to 4.5	3 years 2 months
High	5 to 6	1 year 5 months
Very high	6.5 to 10	8 months

† See the Instructions tab for the definitions of median survival and median 25% progressional to AML and why these times are likely to be longer than shown here.

Your WHO Subtype	To see your WHO subtype, fill in the information marked Ⓦ on the My Data tab. Your blood and bone marrow findings do not match any of the WHO subtypes.
Statistics	Source: National Cancer Institute Source: Incidence, characterization and prognostic significance of chromosomal abnormalities in 640 patients with primary myelodysplastic syndromes (British Journal of Haematology 108(2):346-56, February 2000)

WHO Subtype	WHO Subtype Name	Percentage of MDS Patients	Median Survival †	Percentage Progression to AML †
MDS-RA	Refractory anemia	20% to 30%	2 to 5 years	rare
MDS-RARS	Refractory anemia with ringed sideroblasts	10% to 12%	2 to 5 years	1% to 2%
MDS-RCMD	Refractory cytopenia with multilineage dysplasia	24%	2 years 9 months	11%. Note: To match this classification the dysplasia in your bone marrow should affect at least 10% of the cells in 2 (or 3) cell types.
MDS-RAEB-1	Refractory anemia with excess blasts-1	40% (RAEB-1 or RAEB-2)	1 year 6 months	25%
MDS-RAEB-2	Refractory anemia with excess blasts-2	40% (RAEB-1 or RAEB-2)	10 months	33%
MDS-Del(5q)	MDS with the 5q- syndrome	about 5% (more common in women than men)	Longer survival
MDS-U	Unclassifiable MDS	MDS that doesn't fall into the other categories
AML	Acute myeloid leukemia	not classified as MDS

† See the Instructions tab for the definition of median survival and percentage progression to AML and why survival times are likely to be longer than shown here.

Your WPSS Score	If you have a WPSS score we'll explain how it was computed. To see your WPSS score, fill in the information marked Ⓢ on the My Data tab. To see your WPSS score, fill in both the chromosome and transfusion information on the My Data tab.
Your WPSS Classification	Your WPSS classification is determined by your WPSS score.
Statistics	Source: Time-Dependent Prognostic Scoring System for Predicting Survival and Leukemic Evolution in Myelodysplastic Syndromes (Journal of Clinical Oncology 26 (7): 1181-1182, March 2008)

WPSS Category	Point Range	Median Survival †	Two-year Progression to AML †
Very low	0	8 years 7 months to 11 years 9 months	0% to 3%
Low	1	5 years 6 months to 6 years	6% to 11%
Intermediate	2	3 years 4 months to 4 years	21% to 28%
High	3 or 4	1 year 9 months to 2 years 2 months	38% to 52%
Very high	5 or 6	9 months to 1 year	79% to 80%

† See the Instructions tab for the definitions of median survival and two-year progression to AML and why survival times are likely to be longer than shown here.

Your FAB Subtype	To see your FAB subtype, fill in the information marked Ⓕ on the My Data tab. Your blood and bone marrow findings do not match any of the FAB subtypes.
Statistics	Source: National Cancer Institute

FAB Subtype	FAB Subtype Name	Percentage of MDS Patients	Median Survival †	Progression to AML †
MDS-RA	Refractory anemia	20% to 30%	2 to 5 years	rare
MDS-RARS	Refractory anemia with ringed sideroblasts	10% to 12%	2 to 5 years	1% to 2%
MDS-RAEB	Refractory anemia with excess blasts	40%	1 year 6 months	25%
MDS-RAEB-t	Refractory anemia with excess blasts in transformation	25%	6 months	75%
CMML	Chronic myelomonocytic leukemia	not classified as MDS
AML	Acute myeloid leukemia	not classified as MDS

† See the Instructions tab for the definitions of median survival and progression to AML and why survival times are likely to be longer than shown here.

Privacy: The MDS Classification Tool does not store, save, or upload your data to Marrowforums. The form is cleared of all data each time you load the page or click the Clear Form button. The data you fill in is only in your browser and is used only to help you understand your own MDS subtype. We encourage you to protect the privacy of your medical information.

Feedback: Marrowforums would like to hear your comments on its MDS Classification Tool, to improve the tool and make it as accurate, informative, and useful as possible. To share your thoughts you can post comments in the Site Comments forum section or contact us privately. You're also welcome to post questions if you would like help using the MDS Classification Tool.