Age-adjusted IPSS-R risk categories. The nomogram describes predicted survival based on patient age and IPSS-R risk status (IPSS-RA). To determine an age-adjusted risk categorization, for example, follow the horizontal line, starting at the IPSS-R risk score 3.5 on the vertical axis (Int [Intermediate] risk category per Table 4) to the age of the patient and record the color at that point. If the patient is 45 years, the 3.5′-line and the vertical 45-year line cross in the gray field, placing the patient in the Low risk category, whereas if the patient is 95 years the 3.5′-line and the 95-year line cross in the yellow field, placing the patient in the Intermediate risk category. As indicated, for most patients in the Very high risk category there is no change of risk group, whereas for most patients in the lower risk categories there is greater possibility of category change. Note the “dotted” vertical line at 70 years, which is at the median age of the IWG-PM patient cohort from which the basic risk category scores were calculated (ie, without need for age correction for these patients). The formula to generate the age-adjusted risk score in the figure: (years − 70) × [0.05 − (IPSS-R risk score × 0.005)]. Example: For the 45-year-old patient with an IPSS-R risk score of 3.5 (Intermediate risk): (45-70) × [0.05 − (3.5 × 0.005)] = −0.81. Thus, 3.5-0.8 = 2.7 [age-adjusted IPSS-R score, IPSS-RA: Low risk].