The diagnosis and classification of myelodysplastic syndromes (MDS) are based on cytomorphology and cytogenetics (WHO classification). Prognosis is best defined by the Revised International Prognostic Scoring System (IPSS-R). In recent years, an increasing number of molecular aberrations have been discovered. They are already included in the classification (e.g., SF3B1) and, more importantly, have emerged as valuable markers for better classification, particularly for defining risk groups. Mutations in genes such as SF3B1 and IDH1/2 have already had an impact on targeted treatment approaches in MDS.

1.
Greenberg P, Cox C, LeBeau MM, Fenaux P, Morel P, Sanz G, et al: International Scoring System for evaluating prognosis in myelodysplastic syndromes. Blood 1997; 89: 2079–2088.
2.
Greenberg PL, Tuechler H, Schanz J, Sanz G, Garcia-Manero G, Sole F, et al: Revised International Prognostic Scoring System (IPSS-R) for myelodysplastic syndromes. Blood 2012; 120: 2454–2465.
3.
della Porta MG, Tuechler H, Malcovati L, Schanz J, Sanz G, Garcia-Manero G, et al: Validation of WHO classification-based Prognostic Scoring System (WPSS) for myelodysplastic syndromes and comparison with the revised International Prognostic Scoring System (IPSS-R). A study of the International Working Group for Prognosis in Myelodysplasia (IWG-PM). Leukemia 2015; 29: 1502–1513.
4.
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues, ed 5. Lyon, IARC, 2017.
5.
Arber DA, Orazi A, Hasserjian R, Thiele J, Borowitz MJ, Le Beau MM, et al: The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia. Blood 2016; 127: 2391–2405.
6.
Papaemmanuil E, Gerstung M, Malcovati L, Tauro S, Gundem G, Van Loo P, et al: Clinical and biological implications of driver mutations in myelodysplastic syndromes. Blood 2013; 122: 3616–3627.
7.
Haferlach T, Nagata Y, Grossmann V, Okuno Y, Bacher U, Nagae G, et al: Landscape of genetic lesions in 944 patients with myelodysplastic syndromes. Leukemia 2014; 28: 241–247.
8.
Malcovati L, Hellstrom-Lindberg E, Bowen D, Ades L, Cermak J, Del Canizo MC, et al: Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet. Blood 2013; 122: 2943–2964.
9.
Bejar R, Stevenson K, Abdel-Wahab O, Galili N, Nilsson B, Garcia-Manero G, et al: Clinical effect of point mutations in myelodysplastic syndromes. N Engl J Med 2011; 364: 2496–2506.
10.
Papaemmanuil E, Cazzola M, Boultwood J, Malcovati L, Vyas P, Bowen D, et al: Somatic SF3B1 mutation in myelodysplasia with ring sideroblasts. N Engl J Med 2011; 365: 1384–1395.
11.
Rose D, Kohlmann A, Nagata Y, Ogawa S, Haferlach C, Kern W, et al: A robust molecular pattern for myelodysplastic syndromes in two independent cohorts investigated by next-generation sequencing can be revealed by comparative bioinformatic analyses. Br J Haematol 2014; 167: 278–281.
12.
Meggendorfer M, de Albuquerque A, Nadarajah N, Alpermann T, Kern W, Steuer K, et al: Karyotype evolution and acquisition of FLT3 or RAS pathway alterations drive progression of myelodysplastic syndrome to acute myeloid leukemia. Haematologica 2015; 100:e487–e490.
13.
Meggendorfer M, Haferlach C, Kern W, Haferlach T: Molecular analysis of myelodysplastic syndrome with isolated deletion of the long arm of chromosome 5 reveals a specific spectrum of molecular mutations with prognostic impact: a study on 123 patients and 27 genes. Haematologica 2017; 102: 1502–1510.
14.
Zahid MF, Patnaik MM, Gangat N, Hashmi SK, Rizzieri DA: Insight into the molecular pathophysiology of myelodysplastic syndromes: targets for novel therapy. Eur J Haematol 2016; 97: 313–320.
15.
Matthijs G, Souche E, Alders M, Corveleyn A, Eck S, Feenstra I, et al: Guidelines for diagnostic next-generation sequencing. Eur J Hum Genet 2016; 24: 2–5.
16.
Richards S, Aziz N, Bale S, Bick D, Das S, Gastier-Foster J, et al: Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med 2015; 17: 405–424.
17.
Rehm HL, Bale SJ, Bayrak-Toydemir P, Berg JS, Brown KK, Deignan JL, et al: ACMG clinical laboratory standards for next-generation sequencing. Genet Med 2013; 15: 733–747.
18.
Richards CS, Bale S, Bellissimo DB, Das S, Grody WW, Hegde MR, et al: ACMG recommendations for standards for interpretation and reporting of sequence variations: revisions 2007. Genet Med 2008; 10: 294–300.
19.
Jaiswal S, Fontanillas P, Flannick J, Manning A, Grauman PV, Mar BG, et al: Age-related clonal hematopoiesis associated with adverse outcomes. N Engl J Med 2014; 371: 2488–2498.
20.
Valent P, Orazi A, Steensma DP, Ebert BL, Haase D, Malcovati L, et al: Proposed minimal diagnostic criteria for myelodysplastic syndromes (MDS) and potential pre-MDS conditions. Oncotarget 2017; 8: 73483–73500.
21.
Steensma DP, Bejar R, Jaiswal S, Lindsley RC, Sekeres MA, Hasserjian RP, Ebert BL: Clonal hematopoiesis of indeterminate potential and its distinction from myelodysplastic syndromes. Blood 2015; 126: 9–16.
22.
Malcovati L, Galli A, Travaglino E, Ambaglio I, Rizzo E, Molteni E, et al: Clinical significance of somatic mutation in unexplained blood cytopenia. Blood 2017; 129: 3371–3378.
23.
Baer C, Pohlkamp C, Haferlach C, Kern W, Haferlach T: Molecular patterns in cytopenia patients with our without evidence of myeloid neoplasm – a comparison of 756 cases. Leukemia 2018, DOI: 10.1038/s41375-018-0119-8.
24.
Kennedy JA, Ebert BL: Clinical implications of genetic mutations in myelodysplastic syndrome. J Clin Oncol 2017; 35: 968–974.
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