MDS is a heterogeneous group of clonal conditions arising from somatic mutations in hematopoietic stem and progenitor cells (HSPCs), mainly affecting elderly individuals
[1]. Ineffective hematopoiesis in MDS is characterized by a vicious circle of maturation defects (dysplasia), inflammation in the bone marrow (BM) microenvironment and cytopenia in peripheral blood (PB), which is accompanied by variable risk of progressing towards secondary Acute Myeloid Leukemia (sAML)
[2]. The median age at presentation is above 70 years, with an age-standardized incidence-rate of 3–5 cases per 100,000 patient-years and a prevalence of 20 patients per 100,000 individuals
[3]. The age-specific incidence-rate increases progressively with age, with 50 cases per 100,000 patient-years in individuals 75 years
[3][4]. Males are predominantly affected, with the exception of MDS with isolated del(5q), which is more frequent in females. Therapy-related MDS is estimated to represent 10% of all MDS cases, though precise incidence rates cannot be determined from current epidemiological data
[5][6]. Although generally a disease of the elderly, MDS can occur at any age. The presence of genetic predisposition syndromes should be thoroughly investigated in childhood or younger adults (40 years). In such cases, multiple organs can be affected, and these individuals carry a risk for increased toxicity to chemotherapy and development of other cancers
[7][8].