ELN vs. IPSS-M in MDS/AML: Which Prognostic System Should Guide Clinical Decision-Making?

Abstract

Simple Summary Myelodysplastic syndrome/acute myeloid leukemia (MDS/AML) is a recently recognized overlap entity that exhibits biological and clinical features intermediate between myelodysplastic syndromes and acute myeloid leukemia. Its emergence has challenged the application of traditional prognostic systems developed for either disease. This review examines the biological characteristics of MDS/AML and evaluates the performance of the Molecular International Prognostic Scoring System (IPSS-M) and the European LeukemiaNet (ELN) classifications in this setting. Current evidence supports IPSS-M as the preferred framework for baseline disease-specific prognostic assessment, whereas ELN-based classifications provide complementary AML-oriented molecular and treatment-contextual information. Neither framework should independently determine treatment intensity. Instead, prognosis, patient fitness and transplant eligibility, molecular characteristics, treatment context, and response should be integrated to guide individualized management of patients with MDS/AML.