The pathogenesis of MDS includes initial ancestral lesions, often in the form of early CHIP (clonal hematopoiesis with indeterminate potential)-type or CHOP (clonal hematopoiesis with oncogenic potential)-type alterations followed by the acquisition of additional genetic aberrations (late and/or transforming events) that result in MDS, often with a highly diverse clonal hierarchy. This evidence concerns the gene DDIT3 and myelodysplastic syndrome.