Furthermore, it has been shown in a large cohort of MDS patients that the allelic state of TP53 (mono-allelic versus bi-allelic alterations) is critical for prognostication in MDS, as multi-hit (bi-allelic) TP53 lesions, which are found in approximately 2/3 of MDS with TP53 aberrations, may predict risk of death and leukemic transformation independently of the IPSS-R, whereas MDS with monoallelic TP53 alterations seems to behave similarly to MDS with wild-type TP53 with respect to hematologic parameters and outcomes [19]. Here, TP53 is linked to myelodysplastic syndrome.