Clinical utility and prognostic accuracy of the molecular International Prognostic Scoring System versus Revised International Prognostic Scoring System in myelodysplastic syndromes: A systematic review

Background: The molecular International Prognostic Scoring System (IPSS-M) was introduced to integrate genomic data into Myelodysplastic syndromes risk stratification. We systematically reviewed its performance against the existing standard, the Revised International Prognostic Scoring System (IPSS-R), to evaluate its prognostic utility. Methods: A Preferred Reporting Items for Systematic Reviews and Meta-analyses-compliant search of PubMed, Embase, and Cochrane was conducted (June 2022–December 2025) for studies validating IPSS-M. Heterogeneity was assessed using the I 2 statistic. Results: Twelve validation studies were identified. The IPSS-M significantly outperformed the IPSS-R in prognostic discrimination, with a concordance index (C-index) for overall survival of 0.81 versus 0.71, and demonstrated high accuracy in predicting acute myeloid leukemia (AML) transformation (C-index 0.91). However, heterogeneity across cohorts regarding sequencing depth and treatment eras was noted. Conclusion: IPSS-M provides superior risk discrimination, particularly for patients previously classified as “Intermediate” risk by IPSS-R. While promising as an advanced prognostic tool, prospective validation is required to confirm its role in guiding therapeutic interventions.