Composition of HR features according to updated IMS/IMWG-HR classification. (A) Sankey plot illustrating the composition and contribution of individual risk factors to the updated IMS/IMWG-HR classification. Six groups are displayed based on combinatorial risk features, including HRCA count, GEP signature, and isolated b2m elevation. Elevated b2m is subdivided by creatinine levels below or above the ULN, according to the IMS/IMWG-HR definition. One patient with GEP-HR carried an isolated del(17p) and was therefore also classified as IMS/IMWG-HR. TP53 mutation status was not included in this analysis because only 11 patients in the study had available information. (B) Co-occurrence of HR genetic features in patients harboring del(1p32). Each row represents 1 of 19 individual patients, while columns indicate the presence (gray) or absence (white) of an HR feature, including IMS/IMWG-defined HRCAs and GEP-HR. Biallelic del(1p32) are highlighted in dark red. ULN, upper limit of normal. Figure created with biorender.com. Houlston R. (2025) https://biorender.com/0vv82j9.