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DIPSS / DIPSS-Plus for Myelofibrosis

Dynamic prognostic scoring for primary myelofibrosis survival.

DIPSS / DIPSS-Plus for Myelofibrosis
Age >65 years
Constitutional symptoms (weight loss, fever, night sweats)
Hemoglobin <10 g/dL
Leukocyte count >25×10⁹/L
Circulating blasts ≥1%
Unfavorable karyotype (complex, or +8, -7/7q-, i(17q), inv(3), 12p-, or 11q23 rearrangement)
Platelet count <100×10⁹/L
Red-cell transfusion dependent
ResultLow risk (DIPSS-Plus)

DIPSS-Plus median overall survival ≈ 185 months.

DIPSS score / category
0 points (Low)
DIPSS-Plus score
0 points
DIPSS-Plus risk / median OS
Low (185 months)

When to use

  • Prognosis and treatment planning (including transplant timing) at any point during the course of primary or secondary myelofibrosis.

Formula

DIPSS (0-6): 1 point each for age>65, constitutional symptoms, WBC>25x10^9/L, blasts≥1%; 2 points for Hb<10 g/dL. DIPSS categories map to added points (Low=0, Int-1=1, Int-2=2, High=3), then +1 point each for unfavorable karyotype, platelets<100x10^9/L, and transfusion dependence for the DIPSS-Plus score (0-6).

Pearls and pitfalls

  • Unlike the original IPSS, DIPSS can be applied at any time point in the disease course, not just at diagnosis.
  • Karyotype, platelet count, and transfusion need each independently predict survival beyond DIPSS alone.

References

  1. Passamonti F, et al. Blood. 2010;115(9):1703-8.
  2. Gangat N, et al. J Clin Oncol. 2011;29(4):392-7.