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Background  Telomere erosion can lead to genomic instability and cancer progression. It has been suggested that the shortest telomere, not the average telomere length (TL), is critical for cell viability. Some studies have shown shorter TL in myelodysplastic syndrome (MDS) patients but the critically short telomeres, the variability of TL within individual patient has not been evaluated. Thus, we aimed to investigate the TL of MDS patients and assessed the association of TL with recurrent genetic mutations in MDS.    Methods  We measured the TL of bone marrow nucleated cells for diagnostic samples at a single-cell level by quantitative fluorescence in situ hybridization (Q-FISH) for 58 MDS patients and analyzed the minimum, median, average, standard deviation, average of the 0th to 10th percentile TL within a patient, and the proportion of cells with TL that is shorter than the lowest 10th percentile of the normal control (NC). The correlations of TL to clinical parameters, cytogenetic results, and genetic mutations were assessed.    Results  MDS patients showed eroded telomeres and narrow distribution compared to the NC ( P  < 0.001,  P  = 0.018, respectively). Patients with mutation showed significantly lesser cells with short TL, below the lowest 10th percentile of the NC ( P  = 0.017), but no differences in TL were found according to mutations/cytogenetic abnormalities except for  CSF3R  mutation. However, those patients with a high percentage (≥80 %) of cells with short TL showed poorer overall survival ( P  = 0.021), and this was an independent prognostic factor, along with  TP53 ,  U2AF1  mutation, and high BM blast count ( P  = 0.044, 0.001, 0.004, 0.012, respectively).    Conclusions  The shortest TL, which determines the fate of the cell, was significantly shorter, and higher burden of cells with short TL were found in MDS, which correlated with poor survival, suggesting the need to measure TL in single cells by Q-FISH.    Electronic supplementary material  The online version of this article (doi:10.1186/s13045-016-0287-9) contains supplementary material, which is available to authorized users.

Short telomere length and its correlation with gene mutations in myelodysplastic syndrome