Because the IPSS and IPSS-R do not include somatic mutations, patients may be misclassified as having LR-MDS when, in fact, their disease will behave more aggressively due to high risk somatic mutations such as RUNX1, ASXL1, and TP53. Hence, the approach to treatment, including alloBMT, should follow a HR-MDS paradigm in such patients. This evidence concerns the gene RUNX1 and myelodysplastic syndrome.