It is also an important point that the mutations operate with other mutations in concert and thus higher occurrence of preceding 5q- aberration may have added to selection (during clonal evolution) of distinct TP53 mutations (observed in up to 31% of 5q- patients) [16] that are not as aggressive and still may provide certain cell-survival benefit for maturing blood elements to maintain residual hematopoiesis while preventing rapid progression to MDS/AML. This evidence concerns the gene TP53 and myelodysplastic syndrome.