TP53 and myelodysplastic syndrome: Patients with t-MDS or t-AML have similar survival rates while patients with complex and unfavorable karyotypes tend to have poorer prognosis regardless of morphologic presentation and myeloblast percentage.2 Mutations in TP53 and ATM (ataxia telangiectasia mutated) are considered risk factors due to their important roles in the DNA damage response (DDR) pathways.3, 4 At present there is no active medical intervention to prevent the risk of these therapy-induced cancers.