Higher bone marrow blast percentage(Refer to <5%, 5%–10%: HR=4.587, 95%CI 2.214 to 9.504, P<0.001, >10%: HR=9.352, 95%CI 4.049 to 21.600, P<0.001), IPSS-R cytogenetic risk groups(HR=2.603, 95%CI 1.229–5.511, P=0.012), DNMT3A mutation(HR=4.507, 95%CI 1.889–10.753, P=0.001), and NPM1 mutation(HR=3.341, 95%CI 1.164–9.591, P=0.025)were all independently associated with LT in MDS patients, according to results of multivariate Cox regression. This evidence concerns the gene NPM1 and myelodysplastic syndrome.