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Myelodysplastic syndromes (MDS) are a heterogeneous group of clonal hematopoietic disorders characterized by inefficient hematopoiesis, cytopenias and an increased risk of progression to acute myeloid leukemia.1 Common prognostic scoring methods, such as the International Prognostic Scoring System for MDS (IPSS), use clinical features and karyotypic abnormalities to stratify patients into risk groups that form the basis for clinical treatment guidelines.2 However, more than half of all MDS patients display a normal karyotype and patients with identical chromosomal abnormalities often have varied clinical outcomes. Therefore, additional prognostic indicators that can refine prognosis in MDS patients could help determine the optimal form and timing of therapy.

NRAS mutations with low allele burden have independent prognostic significance for patients with lower risk myelodysplastic syndromes