However, some patients with LR-MDS based on IPSS or IPSS-R scoring should be considered for transplant in the setting of other high risk features including high risk clonal mutations such as TP53, in the presence of significant bone marrow fibrosis, intolerance or contraindication to available therapies, and transfusion dependent patients who fail to achieve a hematologic response even after best available therapy (29). Here, TP53 is linked to myelodysplastic syndrome.