The Impact of Blast Percentage on Posttransplant Outcomes of Patients With Myelodysplastic Syndromes: A Retrospective Analysis Within the IPSS‐M Framework

Blast percentage is crucial for myelodysplastic syndrome (MDS) diagnosis and risk stratification, but its role is now less prominent due to comprehensive genetic-based scoring systems like the Molecular International Prognostic Scoring System (IPSS-M). Originally, blast percentage was an independent categorical variable for prognosis, but in the IPSS-M, it is treated as a continuous variable. We hypothesize that blast percentage should still hold categorical value within genetic-based systems like the IPSS-M, especially for predicting transplant outcomes. A total of 225 MDS patients posttransplantation were retrospectively studied for blast percentage and genetic impact. We identified significant disparities in relapse rates, with a marked contrast between the MDS with increased blasts (IBs) group and the MDS with low blasts group, achieving statistical significance. Intriguingly, within the IB cohort, a pronounced divergence in relapse rates was noted between the high and low risk subgroups within the IB-1 group, but not the IB-2 group. Furthermore, the combined model of blast percentage and IPSS-M demonstrated enhanced prognostic performance, with a higher C-index and lower information criteria than IPSS-M alone, indicating the synergistic prognostic value of these two factors. Our study underscores the significant value of integrating blast percentage as a categorical variable with the IPSS-M for posttransplant prognosis in MDS patients.