Q41-54: DIPSS Prognosis Score

Question 41: Specify the maximum DIPSS score the patient ever achieved

The DIPSS score is based on five variables including recipient’s age, white blood count (WBC), hemoglobin, peripheral blood blasts and constitutional symptoms. Each variable is assigned a point value which are added together to determine the overall score. Refer to Tables 1 and 2.

Report the maximum DIPSS score the recipient ever achieved between diagnosis and the start of the preparative regimen (or infusion if no preparative regimen was given) in question 41. Note the maximum score that can be reported is 6.

Table 1. DIPSS variables

Prognostic Variable	0 Points	1 Point	2 Points
Age (years)	≤ 65	>65
WBC (x 109 / L)	≤ 25	>25
Hemoglobin (g / dL)	≥ 10		<10
Peripheral blood blasts	< 1	≥ 1
Constitutional symptoms	No	Yes

Table 2. DIPSS score, risk category, and prognosis

DIPSS score	DIPSS risk category	Median OS (years)
0	Low	Not reached
1-2	Intermediate – 1	14.2
3-4	Intermediate – 2	4
5-6	High	1.5

!If the recipient achieves their maximum DIPSS score multiple times prior to infusion, report the time point (question 42) and laboratory values (questions 43-54) from the first time their maximum DIPSS score was documented.

Question 42: Specify when maximum DIPSS score was documented

Specify when the maximum DIPSS score was documented.

“At diagnosis” is defined as any time between the date of diagnosis and the start of any treatment for MDS.

“Between diagnosis and the preparative regimen” is defined as any time which cannot be reported as part of either of the two time points (i.e., “at diagnosis” or “at last evaluation prior to the start of prep”).

“At last evaluation prior to the start of the preparative regimen” is defined any time during the recipient’s work-up for HCT or cellular therapy (generally within 30 days of the start of the preparative regimen or infusion).

*Questions 43-54 must only be completed if the timepoint selected in question 42 is “between diagnosis and the preparative regimen.” If this timepoint is selected, report the clinical and laboratory assessments used to determine the maximum IPSS-R score in questions 43-54.

Question 43: Date CBC drawn

Report the date the CBC was drawn at the time the maximum DIPSS score was determined between diagnosis and the start of the preparative regimen.

Question 44-53: Provide the lab values used to determine the maximum DIPSS score

For each value below, indicate if the result was “known” or “unknown” when determining the maximum DIPSS score. Indicate the units for each testing, taking care to convert them to a unit available on the form, if necessary.

WBC: The white blood cell count is a value that represents all the white blood cells in the blood. If the count is too high or too low, the ability to fight infection may be impaired.
Blasts in blood: Indicate whether the percent blasts in the peripheral blood is “Known” or “Unknown” when determining the maximum IPSS-R score. If a differential was performed and there were no blasts present in the peripheral blood, the laboratory report may not display a column for blasts. In this case, it can be assumed that no blasts were present and “0” can be reported on the form.
Hemoglobin: Hemoglobin is a molecule in red blood cells that delivers oxygen to tissues throughout the body. A low hemoglobin count is considered “anemia” and blood transfusions, or growth factors may be required to increase the hemoglobin level. Also indicate if the recipient received a red blood cell transfusion within 30 days prior to CBC blood draw.
Platelets: Platelets are formed elements within the blood that help with coagulation. A low platelet count, called thrombocytopenia, may lead to easy bleeding or bruising. Thrombocytopenia may require platelet transfusions. Indicate if the recipient received a platelet transfusion within 7 days prior to CBC blood draw.

Questions 54: Did the recipient have constitutional symptoms ( > 10% weight loss in six months, night sweats, unexplained fever higher than 37.5°C) when determining the maximum DIPSS score

Indicate if constitutional symptoms were present when at the time of the maximum DIPSS score. Constitutional symptoms are often called “B” symptoms and include unexplained fever greater than 37.5°C (99.5°F), night sweats, or unexplained weight loss in the six months before .

Report “yes” if any constitutional symptoms were present within six months before when determining the maximum DIPSS score.

Report “no” if constitutional symptoms were not present at this timepoint.

Report “unknown” if it is not possible to determine the presence or absence of constitutional symptoms at this timepoint.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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