We had previously described a ‘Goldilocks’ effect of Q1 and Q4 levels of Preferentially Expressed Antigen in Melanoma (PRAME) being associated with poor survival in myelodysplastic syndrome patients [22] that we had suggested was caused by high levels of PRAME being associated with more aggressive/difficult to treat blast cells and, conversely, low levels of PRAME providing insufficient antigen to ignite an immune response, thus both Q1 and Q4 levels of PRAME expression were associated with poor survival. Here, PRAME is linked to myelodysplastic syndrome.