Frailty and comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms

Frailty and comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Frailty and comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms Zhijian Xiao, Xin Wang, QIUJIN SHEN, Songyang Zhao, SAIBING QI, and 18 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9173739/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 11 You are reading this latest preprint version Abstract IPSS-M has improved prognostication in MDS by integrating clinical, cytogenetic, and molecular data. Here, we investigate the potential added value of considering frailty and comorbidity for improving prognosis prediction. Using data from a training set of 412 subjects with newly diagnosed MDS, we develop “Integrated IPSS-M”, a risk-stratification model that recalibrates IPSS-M based on age, frailty, and comorbidity. We then confirm the model’s performance on a validation set of 275 subjects. The Integrated IPSS-M showed higher concordance scores for overall survival compared with the IPSS-M (training set, 0.77 [95-percent confidence interval [CI], 0.73, 0.80] vs. 0.68 [0.64, 0.72], P < 0.001; validation set, 0.73 [0.68, 0.78] vs. 0.69 [0.64, 0.74], P = 0.03). Our study indicates that integration of IPSS-M, age, frailty, and comorbidity enhances prognostic accuracy in MDS. These findings suggest that Integrated IPSS-M may inform treatment decision-making and trial enrollment for new therapies. Health sciences/Diseases/Haematological diseases/Haematological cancer/Myelodysplastic syndrome Health sciences/Risk factors Health sciences/Health care/Prognosis Myelodysplastic neoplasms Prognostic model Frailty Comorbidity Full Text Additional Declarations There is NO conflict of interest to disclose. Table 1 and 2 are available in the Supplementary Files section. Supplementary Files Table1.docx Table 1 Table2.docx Table 2 SupplementalMaterial.pdf Supplemental Material Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: revise 29 Apr, 2026 Review # 1 received at journal 27 Apr, 2026 Review # 3 received at journal 17 Apr, 2026 Review # 2 received at journal 14 Apr, 2026 Reviewer # 3 agreed at journal 09 Apr, 2026 Reviewer # 2 agreed at journal 05 Apr, 2026 Reviewer # 1 agreed at journal 30 Mar, 2026 Reviewers invited by journal 30 Mar, 2026 Editor assigned by journal 20 Mar, 2026 Submission checks completed at journal 20 Mar, 2026 First submitted to journal 19 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9173739","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":614791336,"identity":"61c92cf3-6274-4f33-88f2-f99654e21558","order_by":0,"name":"Zhijian 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comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"leukemia","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"leu","sideBox":"Learn more about [Leukemia](http://www.nature.com/leu/)","snPcode":"41375","submissionUrl":"https://mts-leu.nature.com/cgi-bin/main.plex","title":"Leukemia","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature 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Here, we investigate the potential added value of considering frailty and comorbidity for improving prognosis prediction. Using data from a training set of 412 subjects with newly diagnosed MDS, we develop “Integrated IPSS-M”, a risk-stratification model that recalibrates IPSS-M based on age, frailty, and comorbidity. We then confirm the model’s performance on a validation set of 275 subjects. The Integrated IPSS-M showed higher concordance scores for overall survival compared with the IPSS-M (training set, 0.77 [95-percent confidence interval [CI], 0.73, 0.80] vs. 0.68 [0.64, 0.72], P \u003c 0.001; validation set, 0.73 [0.68, 0.78] vs. 0.69 [0.64, 0.74], P = 0.03). Our study indicates that integration of IPSS-M, age, frailty, and comorbidity enhances prognostic accuracy in MDS. These findings suggest that Integrated IPSS-M may inform treatment decision-making and trial enrollment for new therapies.","manuscriptTitle":"Frailty and comorbidity improve IPSS-M prognostic stratification in myelodysplastic neoplasms","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-01 13:31:20","doi":"10.21203/rs.3.rs-9173739/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"revise","date":"2026-04-29T12:12:23+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-28T01:05:55+00:00","index":1,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-17T18:15:41+00:00","index":3,"fulltext":"This content is not available."},{"type":"editorInvitedReview","content":"This content is not available.","date":"2026-04-14T15:30:19+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-04-09T14:56:22+00:00","index":3,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-04-05T11:23:07+00:00","index":2,"fulltext":"This content is not available."},{"type":"reviewerAgreed","content":"This content is not available.","date":"2026-03-30T20:06:53+00:00","index":1,"fulltext":"This content is not available."},{"type":"reviewersInvited","content":"","date":"2026-03-30T18:01:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-20T13:31:46+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-20T13:31:16+00:00","index":"","fulltext":""},{"type":"submitted","content":"Leukemia","date":"2026-03-20T01:38:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"leukemia","isNatureJournal":false,"hasQc":false,"allowDirectSubmit":false,"externalIdentity":"leu","sideBox":"Learn more about [Leukemia](http://www.nature.com/leu/)","snPcode":"41375","submissionUrl":"https://mts-leu.nature.com/cgi-bin/main.plex","title":"Leukemia","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"ejp","reportingPortfolio":"Nature AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"223ed460-cafb-462a-9278-9cbbe618786e","owner":[],"postedDate":"April 1st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":65418153,"name":"Health sciences/Diseases/Haematological diseases/Haematological cancer/Myelodysplastic syndrome"},{"id":65418154,"name":"Health sciences/Risk factors"},{"id":65418155,"name":"Health sciences/Health care/Prognosis"}],"tags":[],"updatedAt":"2026-04-29T12:16:01+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-01 13:31:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9173739","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9173739","identity":"rs-9173739","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}