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MDS escalates from lower-risk to higher-risk classification by IPSS-R (high / very high,...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

IDRF-MDS-HIGH-RISK-IPSS
TypeRed flag
Statusreviewed 2026-04-25 | pending_clinical_signoff
DiseasesDIS-MDS-HR DIS-MDS-LR
SourcesSRC-ESMO-MDS-2021 SRC-IPSS-M-BERNARD-2022 SRC-NCCN-AML-2025

Red Flag Origin

DefinitionMDS escalates from lower-risk to higher-risk classification by IPSS-R (high / very high, >4.5 points) or IPSS-M (High / Very High) — treatment intent shifts from cytopenia management to disease modification + alloHCT bridging
Clinical directionintensify
Categoryhigh-risk-biology
Shifts algorithmALGO-MDS-LR-1L

Trigger Logic

{
  "any_of": [
    {
      "finding": "ipss_r_category",
      "value": "high"
    },
    {
      "finding": "ipss_r_category",
      "value": "very_high"
    },
    {
      "finding": "ipss_m_category",
      "value": "High"
    },
    {
      "finding": "ipss_m_category",
      "value": "Very_High"
    },
    {
      "comparator": ">=",
      "finding": "bm_blasts_pct",
      "threshold": 10
    }
  ],
  "type": "risk_score"
}

Notes

Triggers shift from MDS-LR algorithm (ESA → luspatercept → lenalidomide for del 5q) to MDS-HR algorithm (HMA azacitidine 1L + alloHCT bridge in eligible patients). IPSS-M reclassifies ~46% of patients vs IPSS-R (Bernard et al. 2022) — both are accepted; IPSS-M preferred when molecular data available. The flag also triggers when bm_blasts >= 10% (MDS-IB2 / MDS-EB-2) regardless of IPSS-R math, because that morphology alone qualifies as higher-risk. STUB — requires clinical co-lead signoff.

Used By

Algorithms

Indications